Ps-bpc07-7: reduced efficacy of blood pressure lowering drugs in the presence of diabetes mellitus: results from the triumph randomised controlled trial.

Objective: People with diabetes mellitus (DM) have a higher prevalence of suboptimal blood pressure (BP) control compared to those without DM. Whether the presence of DM affects the ability of antihypertensive therapies to lower blood pressure (BP) is uncertain. We investigated whether DM affects the efficacy of a low dose triple combination pill or usual care among people with mild-moderate hypertension. Design and method: TRIUMPH (TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension) was a randomized controlled open-label trial of patients requiring initiation or escalation of antihypertensive therapy. Patients were randomised to a once-daily low-dose triple combination polypill (telmisartan 20 mg/amlodipine 2.5 mg/chlorthalidone 12.5 mg) or usual care. This analysis compared BP reduction and percentage of time below target BP in people with and without DM, both in the intervention and control groups over 24-week follow-up. Predicted efficacy of prescribed therapy was calculated using the estimation methods of Law et al. Results: The trial randomized 700 patients (56 ± 11yrs, 31% DM). There was no difference in the number of drugs prescribed or predicted efficacy of therapy between people with DM and without DM. However, the observed BP reduction from baseline to week 24 was lower in those with DM compared to non-diabetics in both the triple pill (25/11 vs 31/15 mmHg, p ≦ 0.01) and usual care (17/7 vs 22/11, p ≦ 0.01) groups. People with DM achieved lower time at target BP than non-diabetics on both the triple pill (44% vs 73%, p < 0.001) and usual care (27% vs 51%, p < 0.001). DM was a negative predictor of change in BP (beta-coefficient -0.08, p = 0.02) and spending majority of time at target BP (OR 0.54, p = 0.006). Conclusions: Patients with DM experienced reduced efficacy of BP lowering therapies as compared to patients without DM, irrespective of the type of BP lowering therapy received. The triple pill still produced greater BP reduction compared to usual care in patients with mild-moderate hypertension even in the presence of DM.