TOPSPIN Trial: Three Dual Combination Polypills Show Equal Effectiveness for BP Control in India

A study presented at AHA 2024 found that three dual-combination polypills for hypertension were equally effective in lowering blood pressure (BP) to 140/90 mmHg or less among Indian adults.

The polypills included amlodipine and perindopril, perindopril and indapamide, or amlodipine and indapamide. These combinations were tested in the TOPSPIN trial, involving 1,981 adults aged 30 to 79 across 35 hospitals in India.

Participants had their BP measured at enrollment and after two, four, and six months using 24-hour ambulatory BP monitors and in-clinic readings. At baseline, 55% were on BP-lowering medications, 18.6% had type 2 diabetes, and 6.2% were current smokers.

After six months, all three combinations showed similar BP reductions: approximately 14/8 mmHg lower with ambulatory monitors and 30/14 mmHg lower in clinics. Around 70% of participants achieved BP below 140/90 mmHg, while 40% met the stricter target of 130/80 mmHg.

The polypills demonstrated an excellent safety profile, with fewer than 3% discontinuing due to side effects. The amlodipine-perindopril group showed an additional benefit of reduced fasting blood sugar levels.

Researchers noted these results differ from the CREOLE study, which found amlodipine-based combinations superior in Black adults in Sub-Saharan Africa. This underscores potential population-specific responses to treatments.

The study emphasizes the broader significance of these findings, as South Asians represent 25% of the global population, including over five million in the U.S.

Take-Home Points

• In TOPSPIN, all three combinations were equally effective for Indian adults. In CREOLE, amlodipine-based therapies were superior for Black adults. TOPSPIN used amlodipine-perindopril, perindopril-indapamide, and amlodipine-indapamide as effective combinations. CREOLE found amlodipine-hydrochlorothiazide and amlodipine-perindopril to be the most effective. Both studies reported excellent safety with minimal adverse effects. TOPSPIN showed no combination was superior among Indian adults.CREOLE demonstrated that amlodipine-based therapies were clearly more effective for Black adults. Hypertension treatments should consider genetic and demographic differences. Amlodipine-based combinations are ideal for Black populations, while South Asians benefit from a broader range of effective options.