Certain BP Treatments Less Effective in Patients With Diabetes

Finger with a bead of blood
Finger with a bead of blood
Investigators assessed the impact of diabetes mellitus on the efficacy of a low-dose, triple combination, polypill or standard care for the treatment of hypertension.

Antihypertensive therapy to lower blood pressure (BP) with either a once-daily, low-dose, triple combination polypill or standard care both showed reduced potency in the presence of diabetes mellitus (DM); however, the triple combination polypill achieved greater reductions in BP compared with standard care among patients with mild to moderate hypertension, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

As it is uncertain whether DM impacts the ability of antihypertensive therapies to reduce BP, investigators designed the randomized controlled, open-label TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension (TRIUMPH) trial to investigate how the presence of DM impacts the efficacy of a low-dose, combination polypill compared with standard care.

Patients from urban Sri Lankan hospital clinics requiring initiation or escalation of antihypertensive therapy were randomly assigned to the standard care or intervention group (once-daily, low-dose, triple combination polypill [telmisartan 20 mg, amlodipine 2.5 mg, and chlorthalidone 12.5 mg]). Trial analysis compared reductions in BP and percentage of time at target levels (BP below 140/90 mm Hg) in both groups over 24 weeks of follow-up, stratified by DM presence. Predicted therapy potency was calculated using estimation methods of Law et al.

Among the 700 participants (age, 56±11 years; 58% women; 31% diagnosed with DM), those taking the triple combination pill showed greater reductions in BP at week 24 compared with standard care in both DM and non-DM groups (P >.05 for heterogeneity). DM was a negative predictor of time spent at target BP levels (odds ratio [OR], 0.18; 95% CI, 0.10-0.31; P <.001).

Compared with the non-diabetic group, patients with diabetes showed lower reductions in BP from baseline to week 24 with the triple combination pill (change in systolic BP, 25 vs 31 mm Hg; change in diastolic BP, 11 vs 15 mm Hg; P ≤.01) and standard care (change in systolic BP, 17 vs 22 mm Hg; change in diastolic BP, 7 vs 11 mm Hg; P ≤.01)), respectively. Patients with DM also achieved a lower percentage of time at target BP levels with the triple combination pill (44% vs 73%; P <.001) and standard care (27% vs 51%; P <.001). There were no differences between patients with diabetes vs those without in the number of medications prescribed or the predicted potency of therapy.

Study investigators concluded, “While both drug regimens were associated with reduced potency in the presence of DM, the triple pill achieved greater BP reduction compared to usual care in mild-moderate hypertension.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Gnanenthiran S, Webster R, Salam A, et al. Reduced potency of blood pressure lowering drugs in the presence of diabetes mellitus – results from the triumph randomized controlled trial. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Presentation P2002.

This article originally appeared on The Cardiology Advisor