Elbardisy Shereef, Alotaibi Muteb N, Saad Abdulbadih R, Alhatm Mshal, Alharbi Othman H, Alyaqout Fajer B, Elshaer Omar E, Alazmi Abdulaziz M, Kagita Navyamani V, Allam Ibrahim M, Bhutta Aaima I, Habboush Shady, Sindi Raghad, Aswad Yasein, Alharran Abdullah M
Department of Cardiology, Saudi German Hospital, Dubai, ARE.
College of Medicine, Alfaisal University, Riyadh, SAU.
Cureus. 2024 Sep 6;16(9):e68802. doi: 10.7759/cureus.68802. eCollection 2024 Sep.
Hypertension is a major cause of cardiovascular disease and death worldwide. Low-dose combination therapy is a promising approach for managing hypertension due to its safety and efficacy. This systematic review evaluates the safety and efficacy of a single-pill, low-dose combination of amlodipine, telmisartan, and chlorthalidone for essential hypertension based on evidence from randomized controlled trials (RCTs). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the Cochrane, Scopus, PubMed, and Web of Science databases until July 01, 2024, using the following search string: (telmisartan) AND (amlodipine) AND (chlorthalidone) AND (randomized OR randomly). The quality of the RCTs was assessed using the revised Cochrane risk of bias tool. The primary endpoint was the mean change in sitting systolic blood pressure (BP), with secondary endpoints including BP target achievement rates, BP response rates, and serious treatment-related adverse events. Overall, three RCTs met the inclusion criteria and exhibited a low risk of bias. The doses in the combination pill ranged from 2.5 to 5 mg of amlodipine, 20 to 80 mg of telmisartan, and 4.167 to 25 mg of chlorthalidone. Control groups varied, including usual care, amlodipine 10 mg, and dual therapy of telmisartan and amlodipine. Results showed significant reductions in mean sitting systolic and diastolic BP, improved BP control and response rates, and a generally safe profile with no significant differences in serious adverse events. Despite encouraging data, results should be interpreted with caution due to heterogeneity in doses and control groups. Further research should address the long-term effects and explore predictors of response to this therapy.
高血压是全球心血管疾病和死亡的主要原因。低剂量联合治疗因其安全性和有效性，是治疗高血压的一种有前景的方法。本系统评价基于随机对照试验（RCT）的证据，评估氨氯地平、替米沙坦和氢氯噻嗪单丸低剂量联合治疗原发性高血压的安全性和有效性。我们遵循系统评价和Meta分析的首选报告项目指南，使用以下搜索词在Cochrane、Scopus、PubMed和Web of Science数据库中进行检索，直至2024年7月1日：（替米沙坦）AND（氨氯地平）AND（氢氯噻嗪）AND（随机或随机化）。使用修订后的Cochrane偏倚风险工具评估RCT的质量。主要终点是坐位收缩压（BP）的平均变化，次要终点包括血压达标率、血压反应率和严重治疗相关不良事件。总体而言，三项RCT符合纳入标准，且偏倚风险较低。联合药丸中的剂量范围为氨氯地平2.5至5毫克、替米沙坦20至80毫克和氢氯噻嗪4.167至25毫克。对照组各不相同，包括常规治疗、氨氯地平10毫克以及替米沙坦和氨氯地平的联合治疗。结果显示，坐位收缩压和舒张压的平均值显著降低，血压控制和反应率得到改善，总体安全性良好，严重不良事件无显著差异。尽管数据令人鼓舞，但由于剂量和对照组存在异质性，结果应谨慎解释。进一步的研究应探讨该疗法的长期效果并探索反应的预测因素。
