Comparison of dual therapies for hypertension treatment in India: a randomized clinical trial
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Evidence is lacking for guiding optimal combination hypertension therapy in South Asian patients. Here we investigated the blood pressure (BP)-lowering efficacy and safety of three commonly recommended antihypertensive dual combinations in a multicenter, single-blinded trial conducted in India. We randomized Indians aged 30–79 years (mean age, 52 years) with mean sitting systolic blood pressure (SBP) of 150–179 mmHg on no treatment or an SBP of 140–159 mmHg on monotherapy 1:1:1 to a single-pill combination of amlodipine–perindopril, perindopril–indapamide or amlodipine–indapamide. The primary outcome was the mean change in 24-hour ambulatory SBP at 6 months. Of the 1,981 participants (42% females) enrolled in the trial, 1,637 completed a 24-hour ambulatory BP measurement. All three drug combinations produced similar large reductions in the primary outcome, namely ambulatory (~14/8 mmHg) and office (~30/14 mmHg) BPs after 6 months, such that hypertension control rates (sitting BP < 140/90 mmHg) were achieved in approximately 70% of participants in all three groups. Furthermore, no significant differences in secondary outcomes, such as mean day and night ambulatory and office BPs and hypertension control rates, were observed among the study groups. Thus, in Indian patients, amlodipine–perindopril, perindopril–indapamide and amlodipine–indapamide were all equally well tolerated and equally highly effective in reducing 24-hour ambulatory and office BPs (ClinicalTrials.gov registration: NCT05683301).
Date Issued
2025-09-01
Date Acceptance
2025-06-20
Citation
Nature Medicine, 2025, 31, pp.3169-3175
ISSN
1078-8956
Publisher
Nature Research
Start Page
3169
End Page
3175
Journal / Book Title
Nature Medicine
Volume
31
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
10.1038/s41591-025-03854-w
Publication Status
Published
Date Publish Online
2025-07-25