{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:08:36Z","timestamp":1792166916474,"version":"4.4.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"\n Importance<\/jats:title>\n With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering.<\/jats:p>\n <\/jats:sec>\n \n Design and Setting<\/jats:title>\n \n Randomized, parallel-group, open-label, multicenter trial conducted in\n p<\/jats:bold>\n ublic hospital\u2013based family medicine clinics in Nigeria.\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Black African adults with uncontrolled hypertension (\u2265140\/90 mm Hg) who were untreated or receiving a single blood pressure\u2013lowering drug.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomly allocated to low-dose triple-pill or standard-care protocols. The triple-pill protocol involved a novel combination of telmisartan, amlodipine, and indapamide in triple one-quarter, one-half, and standard doses (ie, 10\/1.25\/0.625 mg, 20\/2.5\/1.25 mg, and 40\/5\/2.5 mg), with accelerated up-titration. The standard-care protocol was the Nigeria hypertension treatment protocol starting with amlodipine (5 mg).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary effectiveness outcome was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of trial treatment due to adverse events, both from randomization to month 6.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The first participant was randomized on July 19, 2022, and the last follow-up visit was on July 18, 2024. Among 300 randomized participants (54% female; mean age, 52 years; baseline mean home blood pressure, 151\/97 mm Hg; and clinic blood pressure, 156\/97 mm Hg), 273 (91%) completed the trial. At month 6, mean home systolic blood pressure was on average 31 mm Hg (95% CI, 28 to 33 mm Hg) lower in the triple-pill protocol group and 26 mm Hg (95% CI, 22 to 28 mm Hg) lower in the standard-care protocol group (adjusted difference, \u22125.8 mm Hg [95% CI, \u22128.0 to \u22123.6];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001]). At month 6, clinic blood pressure control (&amp;lt;140\/90 mm Hg) was 82% vs 72% (risk difference, 10% [95% CI, \u22122% to 20%]) and home blood pressure control (&amp;lt;130\/80 mm Hg) was 62% vs 28% (risk difference, 33% [95% CI, 22% to 44%]) in the triple-pill compared with the standard-care protocol group; these were 2 of 21 prespecified secondary effectiveness end points. No participants discontinued trial treatment due to adverse events.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Among Black African adults with uncontrolled hypertension, a low-dose triple-pill protocol achieved better blood pressure lowering and control with good tolerability compared with the standard-care protocol.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Pan African Clinical Trials Registry Identifier:\n PACTR202107579572114<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.18080","type":"journal-article","created":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T05:30:33Z","timestamp":1725082233000},"page":"1070","source":"Crossref","is-referenced-by-count":45,"title":["Low-Dose Triple-Pill vs Standard-Care Protocols for Hypertension Treatment in Nigeria"],"prefix":"10.1001","volume":"332","author":[{"given":"Dike B.","family":"Ojji","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Abuja, Abuja, Nigeria"},{"name":"University of Abuja Teaching Hospital, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Salam","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Hyderabad, Telangana, India"},{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Prasanna School of Public Health, Manipal Academy of Higher Education, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud U.","family":"Sani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okechukwu S.","family":"Ogah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University College Hospital, Ibadan, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aletta E.","family":"Schutte","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Sydney, New South Wales, Australia"},{"name":"School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Huffman","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Pant","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpita","family":"Ghosh","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Hyderabad, Telangana, India"},{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Prasanna School of Public Health, Manipal Academy of Higher Education, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupasvi","family":"Dhurjati","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josyula K.","family":"Lakshmi","sequence":"additional","affiliation":[{"name":"Indian Institute of Public Health, Hyderabad"},{"name":"Now with The George Institute for Global Health, Hyderabad, Telangana, India"},{"name":"Now with The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Now with Prasanna School of Public Health, Manipal Academy of Higher Education, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanna. R.","family":"Ripiye","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Abuja, Abuja, Nigeria"},{"name":"University of Abuja Teaching Hospital, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikechukwu A.","family":"Orji","sequence":"additional","affiliation":[{"name":"University of Abuja Teaching Hospital, Abuja, Nigeria"},{"name":"Cardiovascular Research Center, University of Abuja, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shehu A.","family":"Kana","sequence":"additional","affiliation":[{"name":"Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tijjani","family":"Abdussalam","sequence":"additional","affiliation":[{"name":"Department of Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulgafar 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