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JAMA

Combination-pill care program lowered blood pressure

The combined program reduced the upper blood pressure reading by 10.1 millimeters of mercury more than standard care over 18 months.

Paper by Jose P Lopez-Lopez, Jacqueline Duncan, Jing Chen, +22 more authorsJiang He · Masira Research Institute · University of Texas Southwestern Medical Center
Figure 1 from JAMA
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Figure 1. Lopez-Lopez et al.

Our read

Interventions
Studied:
Randomized trial in 1,574 adults with uncontrolled hypertension, 18 months, against standard care (Multicenter, registered NCT05405920)
What changed:
The program lowered the upper blood pressure reading by 10.1 millimeters of mercury more than standard care over 18 months
The catch:
Only 1574 of 1706 enrolled participants were included in the primary analysis
Why it’s aging research:
It bears on staying healthy in midlife and later life.

Editor of record: Boris Djordjevic · AgingResearch.News

Paper
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The 1,706 adults with uncontrolled high blood pressure in Colombia and Jamaica averaged 61.4 years old; 69.9% were women. Their 40 primary care clinics participated in an unblinded cluster randomized trial, with clinics assigned to either care strategy.

For 18 months, the program combined supplied combination pills with staff training, health coaching and home blood pressure monitoring. Standard care used guideline-recommended medicines. Among 1,574 participants analyzed, systolic pressure—the upper blood pressure reading—fell by 19.1 millimeters of mercury (mm Hg) with the program versus 9.0 mm Hg with standard care. At 18 months, 69.5% versus 29.2%, respectively, reached blood pressure below 130/80 mm Hg. Serious adverse events—death or hospitalization—occurred in 7.9% versus 9.9%, respectively.

Why it matters

For blood pressure care as people age, the authors suggested that this combined strategy could be adopted more widely, particularly in settings with limited resources.

Caveats

Clinics and participants knew their assignments, and the trial did not separate the pills’ effects from those of the wider care program. The findings concern adults with uncontrolled blood pressure in Colombia and Jamaica, not people whose blood pressure was already controlled.

Where the evidence stands

Health coaching

Humans: replicated by independent labs. Cells, worms or flies and mice: nothing yet.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Against: findings that point the other way from most findings on the same outcome.

Company ties: findings with an author at a company, or from a paper whose competing-interests statement declares ties to one.

  • 9 independent labs in 4 countries
  • 3 findings against
  • Funders: National Health and Medical Research Council and others
  • 4 of 31 findings with company ties

Home blood pressure monitoring

Humans: replicated by independent labs. Cells, worms or flies and mice: nothing yet.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Company ties: findings with an author at a company, or from a paper whose competing-interests statement declares ties to one.

  • 5 independent labs in 2 countries
  • Funder: Wellcome Trust
  • 1 of 11 findings with company ties

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