Treatment Strategies to Control Blood Pressure in People With Hypertension in Tanzania and Lesotho: A Randomized Clinical Trial
An erratum to this article was published (JAMA Cardiol, 1 Apr 2025 ↗)
Primary result · Target BP reached (non-inferiority analysis)Result — go to the resultAdjusted odds ratio 1.18 95% CI 0.87–1.61Authors' conclusion
Results of this randomized clinical trial show that in 2 African settings, for adults with uncomplicated untreated hypertension, a strategy starting a 2-pill low-dose treatment was noninferior to starting stepped monotherapy. Two-pill and 3-pill low-dose strategies were not superior to stepped monotherapy.
Study context
- Population
- Nonpregnant Black African adults with uncomplicated, untreated hypertension, rural Lesotho and Tanzaniarandomized 2:2:1
- Participants
- 1,268 adults
- Comparison
- 2-pill or 3-pill low-dose strategy vs stepped monotherapy
- Monotherapyn = 505reference
- 2-pilln = 510
- 3-pilln = 253
- Primary endpoint
- Proportion reaching target BP (≤130/80 mm Hg if <65 years; ≤140/90 mm Hg if ≥65 years)
- Follow-up
- 12 weeks
Methodological detailsopen-label, parallel, 3-arm, non-inferiority (margin 10%) and superiority, 2 hospitals
- Open-label
- Parallel
- 3-arm
- Non-inferiority (margin 10%) and superiority
- 2 hospitals
Primary result
Target BP reached (non-inferiority analysis)
Adjusted odds ratio
1.18
95% CI 0.87–1.61
Events by treatment group
2-pillvs Monotherapy
aOR 1.18 (95% CI 0.87–1.61)
Non-inferiority margin 10 as printed, not drawn
As reported in the abstract
Further findings
| Outcome | Monotherapy | 2-pill | 3-pill | aOR (95% CI) | P value | |
|---|---|---|---|---|---|---|
| Target BP reached (superiority analysis, multiple imputation) · 12 weeks2-pillvs MonotherapyMultiple imputation for missing outcome data | 49% | 55% | 57% | 1.24 (0.94–1.63) | P = 0.12 | |
| Target BP reached (superiority analysis, multiple imputation) · 12 weeks3-pillvs MonotherapyMultiple imputation for missing outcome data | 1.28 (0.91–1.79) | P = 0.16 | ||||
| 0.512Adjusted odds ratio (log scale) |
Original publication
Treatment Strategies to Control Blood Pressure in People With Hypertension in Tanzania and Lesotho: A Randomized Clinical Trial. JAMA Cardiol. Published 1 April 2025. doi:10.
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