Efficacy and safety of triple versus dual combinations of antihypertensive drugs: A systematic review and meta-analysis of double-blind randomized clinical trials
Dhurjati, R.; Pant, R.; Satheesh, G.; Mittal, A.; Rodgers, A.; Salam, A.
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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.
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