The TRINITY Study: distribution of systolic blood pressure reductions

Background: Elevated systolic blood pressure is more difficult to control than elevated diastolic blood pressure. The objective of this prespecified analysis of the Triple Therapy with Olmesartan Medoxomil, Amlodipine, and Hydrochlorothiazide in Hypertensive Patients Study (TRINITY) was to compare the efficacy of olmesartan medoxomil (OM) 40mg, amlodipine besylate (AML) 10mg, and hydrochlorothiazide (HCTZ) 25mg triple-combination treatment with the component dual-combination treatments in reducing elevated seated systolic blood pressure (SeSBP). Methods: The 12-week TRINITY study randomized participants to either one of the three component dual-combination treatments (OM 40mg/AML 10mg, OM 40mg/HCTZ 25mg, or AML 10mg/HCTZ 25mg) or the triple-combination treatment. The primary outcome of this analysis was the categorical distribution of SeSBP reductions at week 12 from baseline with OM 40mg/AML 10mg/HCTZ 25 mg versus the dual-combination treatments. Results: SeSBP reductions>50mmHg were seen in 24.4% of participants receiving triplecombination treatment versus 8.1%-15.8% receiving dual-combination treatment. More participants receiving triple-combination treatment achieved the SeSBP target of,<140mmHg (73.6% versus 51.3%-58.8%; P< 0.001) and the seated blood pressure target of<140/90mmHg (69.9% versus 41.1%-53.4%; P<0.001). Prevalence and severity of adverse events were similar in all treatment groups. Conclusion: Treatment with OM 40mg/AML 10mg/HCTZ 25mg was well tolerated and more effective in reducing SeSBP than the dual-combination treatments.