LAUSR

Objective: 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 population cohort. Design and method: We considered 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 < 3 or 3 or more high blood pressure (BP) medications 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 ACE-inhibitors/CCBs/Thiazide, ARBs/CCBs/Thiazide or Perindo-pril/Amlodipine/Indapamide, 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 medications. The long term effects of the different antihypertensive medications were compared among the pre-defined groups. Results: On the long-term, combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with better control of diastolic BP and lipid pattern than other triple combination antihypertensive medication. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow-up they neither developed type 2 diabetes nor had a need for a greater number of antihypertensive drugs to improve BP control. Conclusions: Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other combination antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/amlodipine/indapamide is associated with better lipids’ profile than any other considered combination antihypertensive medication.