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This meta-analysis of 17 randomized controlled trials involving 13,461 participants found that triple antihypertensive drug therapy reduced systolic blood pressure by an additional 5.4 mmHg compared to dual therapy (26.9 vs 21.7 mmHg total reduction). Triple therapy also achieved significantly better blood pressure control rates (60% vs 47%) with only a modest increase in treatment withdrawals due to adverse events (4% vs 3%). The blood pressure lowering benefit was more pronounced when adding a third drug to submaximal doses rather than maximal doses of dual therapy.
Why it matters
This evidence supports using triple combination therapy for patients with hypertension who do not achieve adequate blood pressure control on two medications, offering clinicians a well-tolerated strategy to improve cardiovascular outcomes. The findings suggest that adding a third drug at lower doses may be more effective and better tolerated than maximizing doses of two drugs.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
We evaluated the blood pressure (BP) lowering efficacy and safety of triple vs dual therapy of antihypertensive drug (AHTD) combinations, among adults with hypertension. Seventeen randomized, double-blind trials (41 comparisons and 13,461 participants) comparing triple versus dual therapy for 3 weeks identified by multiple literature databases searches including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) until October 2024 were included in the meta-analysis. Triple therapy achieved a greater reduction in systolic BP (SBP) compared with dual therapy (26.9 vs. 21.7 mmHg, mean difference 5.4 mmHg [95% CI, 4.7 to 6.2]). Among patients receiving dual therapy at submaximal and maximal doses, the addition of a third drug further reduced SBP by 7.5 and 3.6 mmHg, respectively. BP control was significantly better with triple therapy (60% vs. 47%, RR=1.34 [1.27 to 1.41]). Withdrawal due to adverse events was slightly higher in the triple therapy group (4% vs. 3%, RR=1.5 [1.2 to 1.8]). Triple AHTD therapy provides superior BP reduction and is well-tolerated compared to dual therapy.