Comparing dual antihypertensive combination therapies in a South Asian population

Three different dual antihypertensive therapies demonstrated their safety and effectiveness among patients from India with uncontrolled blood pressure (BP) in the randomised-controlled TOPSPIN trial. All single-pill therapies were safe and associated with similar rates of hypertension control. These findings are reassuring for the administration of guideline-directed antihypertensive therapies in a large part of the global population.

“There is no randomised evidence to inform initial combination therapy for hypertension management in patients of South Asian origin,” Prof. Dorairaj Prabhakaran (Centre for Chronic Disease Control, India) outlined the need for the current study. The multicentre, single-blind TOPSPIN trial compared 3 dual therapies for hypertension control among patients from India with uncontrolled BP (n=1,981) [1,2]. The 3 dual therapies were amlodipine plus perindopril, amlodipine plus indapamide, and perindopril plus indapamide. The primary outcome was the reduction in 24-hour ambulatory BP at 6 months. Participants had either a ‘sitting office’ systolic BP of 140–159 mmHg and were using 1 antihypertensive agent or a ‘sitting office’ systolic BP of 150–179 mmHg and were untreated.

“There was a mean reduction of 14 mmHg in ambulatory systolic BP across the 3 groups at 6 months,” said Prof. Prabhakaran [1]. “There were no substantial differences between the treatment arms.” Furthermore, about 70% of the participants achieved a BP below 140/90 mmHg, and about 40% reached a BP below 130/80. In total, 2.6% of participants discontinued their study drug due to drug-related adverse events.

“Dual combination hypertensive therapies were effective, well-tolerated, and safe in Indian patients with hypertension,” concluded Prof. Prabhakaran. Discussant Prof. Clara Chow (University of Sydney, Australia) added that “BP differences appeared small and not significantly different between groups, suggesting that all combinations were similarly effective. With limited trial data from the area, TOPSPIN provides important confirmatory evidence that there should be no hesitation in using dual combination BP-lowering medication in the first line in patients with uncontrolled hypertension in India.”

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   1. Prabhakaran D, et al. TOPSPIN: a randomised trial comparing three dual-therapies for hypertension treatment among Indians. LBS.06, AHA Scientific Sessions 2024, 16–18 November, Chicago, USA.
   2. Kiru G, et al. Int J Cardiol Cardiovasc Risk Prev. 2024 Oct 24;23:200346. DOI: 10.1016/j.ijcrp.2024.200346

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Posted on 3 February 2025