VERONICA: Improving BP control in Africa with a simple strategy

A single 3-drug pill (GMRx2) protocol to reduce blood pressure (BP) among Nigerian patients with hypertension yielded excellent efficacy results and a good safety profile, demonstrating that a simple treatment protocol can strongly improve the current standard-of-care for this population.

“There is a need for simple, low-cost, scalable treatment strategies for patients with hypertension in Africa,” according to Dr Dike Ojji (Abuja University, Nigeria) [1]. “Most patients still receive only 1 anti-hypertensive agent, while guidelines recommend that patients should receive at least 2 agents.”

The investigator-initiated VERONICA-Nigeria trial randomised 300 self-identified Black African adults with uncontrolled hypertension from Nigeria 1:1 to a single 3-drug pill-based treatment protocol with a low-dose combination of telmisartan, amlodipine, and indapamide, or to the standard-of-care Nigerian hypertension treatment protocol, which starts with 1 agent (i.e. amlodipine) and may be changed to 2 agents if the result is insufficient. Prof. Ojji and colleagues looked at the change in home-measured systolic BP at 6 months.

After 6 months of treatment, participants in the 3-drug pill/GMRx2 group had an average 5.8 mmHg lower systolic BP than those in the standard-of-care group. For diastolic BP, the corresponding difference was -3.6 mmHg. Furthermore, 62% of the participants in the experimental arm versus 28% of those in the control arm had achieved a BP <130/80 mmHg (P<0.001).

“No patients in either study arm had discontinued treatment due to adverse events,” continued Dr Ojji. “The only safety issue we noticed was a slight increase in hypo-potassium (<3.5 mmol/L) in the GMRx2 arm (34% vs 18%).” When the researchers looked at participants with a potassium level <3.0 mmol/L, they noticed that the proportion had dropped from 34% to 9% in the experimental arm.

In conclusion, the single 3-drug pill protocol was more effective than the standard-of-care BP protocol in lowering BP in Black African patients. The BP control rate at 1 month was 80%, which was maintained throughout the study.

Relevant reading:

• Low-dose 3-drug pill GMRx2 shows promise in lowering BP (ESC 2024)

1. 
   
   1. Ojji D, et al. VERONICA-Nigeria - deliVERy of Optimal blood pressure coNtrol in afrICA. HOTLINE 2, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024