{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T20:32:54Z","timestamp":1772656374906,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005969","name":"University of Bologna","doi-asserted-by":"publisher","award":["RFO2016"],"award-info":[{"award-number":["RFO2016"]}],"id":[{"id":"10.13039\/501100005969","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004740","name":"Fondazione del Monte","doi-asserted-by":"publisher","award":["RF2016"],"award-info":[{"award-number":["RF2016"]}],"id":[{"id":"10.13039\/501100004740","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011725","name":"Servier Laboratories","doi-asserted-by":"publisher","award":["RF"],"award-info":[{"award-number":["RF"]}],"id":[{"id":"10.13039\/501100011725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized Italian cohort. We considered the data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2012 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with &lt;3 or \u22653 antihypertensive drugs without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and\/or thiazide\/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with Perindopril\/Amlodipine\/Indapamide, ACE-inhibitors (other than perindopril)\/CCBs\/Thiazide or ARBs\/CCBs\/Thiazide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive treatments. The long-term (8 years) effects of the different antihypertensive treatments were compared among the pre-defined groups. During the observation period, there was a trend towards increase in both systolic and diastolic blood pressure (BP) in all the investigated subgroups (p for trend &lt;0.05), but in the subgroup of patients treated with Perindopril\/Amlodipine\/Indapamide, such increase was significantly lower than in the other groups (p &lt; 0.05). The combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide\/thiazide-like diuretics was associated with significantly lower diastolic BP (p &lt; 0.05) and more strictly controlled lipid pattern than other triple combination of anti-hypertensive medications. Patients treated with Perindopril\/Amlodipine\/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow up none of them developed type 2 diabetes, nor had a need for a greater number of antihypertensive drugs to improve BP control, mainly because of a more stable BP control. Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides\/thiazide-like diuretics is more effective than other triple antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril\/Amlodipine\/Indapamide is associated with more protective metabolic profile than any other considered combination antihypertensive medications.<\/jats:p>","DOI":"10.3390\/jcm10245921","type":"journal-article","created":{"date-parts":[[2021,12,19]],"date-time":"2021-12-19T20:37:27Z","timestamp":1639946247000},"page":"5921","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Long-Term Impact of Different Triple Combination Antihypertensive Medications on Blood Pressure Control, Metabolic Pattern and Incident Events: Data from the Brisighella Heart Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4367-3884","authenticated-orcid":false,"given":"Arrigo","family":"Cicero","sequence":"first","affiliation":[{"name":"Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Sant\u2019Orsola-Malpighi University Hospital, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7853-0042","authenticated-orcid":false,"given":"Federica","family":"Fogacci","sequence":"additional","affiliation":[{"name":"Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Sant\u2019Orsola-Malpighi University Hospital, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Rizzoli","sequence":"additional","affiliation":[{"name":"Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Sant\u2019Orsola-Malpighi University Hospital, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"D\u2019Addato","sequence":"additional","affiliation":[{"name":"Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Sant\u2019Orsola-Malpighi University Hospital, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-8781","authenticated-orcid":false,"given":"Claudio","family":"Borghi","sequence":"additional","affiliation":[{"name":"Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Sant\u2019Orsola-Malpighi University Hospital, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1016\/S0140-6736(21)00590-0","article-title":"Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: An individual participant-level data meta-analysis","volume":"397","author":"Rahimi","year":"2021","journal-title":"Lancet"},{"key":"ref_2","first-page":"224","article-title":"Double or triple combination therapy in systemic arterial hypertension: To whom, when and with what?","volume":"156","author":"Alcocer","year":"2020","journal-title":"Gac. Med. 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