The VERONICA-Nigeria trial, published in JAMA in 2024, evaluated the efficacy and safety of a low-dose triple-pill protocol (telmisartan, amlodipine, and indapamide) versus a standard-care protocol for managing hypertension in Black African adults. This parallel-group, open-label, randomized controlled trial involved 300 patients from Nigeria.
Key Findings:
- Primary Outcome: The difference in home seated mean systolic blood pressure (SBP) from randomization to month 6 was more favorable in the triple-pill group (-31 mm Hg) compared to the standard-care group (-26 mm Hg). The adjusted difference was -5.8 mm Hg (95% CI: -8.0 to -3.6, P < 0.001).
- Secondary Outcomes:
- At month 6, clinic blood pressure control (<140/90 mm Hg) was achieved in 82% of the triple-pill group versus 72% of the standard-care group. The risk difference was 10% (95% CI: -2 to 20).
- At month 6, home blood pressure control (<130/80 mm Hg) was achieved in 62% of the triple-pill group compared to 28% in the standard-care group. The risk difference was 33% (95% CI: 22 to 44).
Conclusion:
Among Black African adults with uncontrolled hypertension, the low-dose triple-pill protocol demonstrated superior blood pressure reduction and better overall control compared to the standard-care protocol. The triple-pill protocol was well tolerated and resulted in a significant improvement in both clinic and home blood pressure control over 6 months.
This trial highlights the potential of simplified, fixed-dose combinations in achieving better hypertension outcomes, particularly in populations with high rates of uncontrolled hypertension.