This story rehashes a news release about a study that found a “triple pill” containing low doses of three blood pressure medications was more effective that the “usual care” offered to patients diagnosed with high blood pressure.
The story addresses a key caveat — that the study has not been published in a journal and therefore hasn’t been rigorously scrutinized. However, it doesn’t give a clear description of what the comparison therapies (aka “usual care”) were. Nor does it provide cost data for the combination pill, which seems to be a key drawback since the study aims to explore whether it can be used to improve blood pressure treatment worldwide. Most significantly, it lacks independent sources who could weigh in on the significance of the findings.
Blood pressure is not well-controlled for many people, particularly in low- and middle-income countries, according to the lead author of this study.
Helping people access effective, affordable blood pressure treatments is important research. But this story’s parroting of a news release doesn’t help readers much. Adding contextual information and independent expert viewpoints goes a long way.
The story doesn’t say how much the triple pill costs, or how that cost compares with “usual care.”
On GoodRx, 30 tablets of a telmisartan/amlodipine combination runs around $60, while 30 tabets of cholorthalidone is about $17. However, all of the dosages available online were twice what was used in the study.
According to a news release, the researchers are evaluating whether the combination pill is cost-effective solution for blood pressure control.
Among those who took the so-called “triple pill” for six months, 70 percent had achieved their blood pressure targets, compared with 55 percent of those who received their usual care. The story doesn’t state this, but we found via the news release that “usual care” meant taking whatever blood pressure medicine their doctor prescribed.
Also, there was no information in the news story about what the blood pressure targets were. According to the release, the blood pressure target was 140/90 mm Hg or less, with a lower target of 130/80 mm Hg or less for those with diabetes or chronic kidney disease.
Lastly, the story should have cautioned that lowering blood pressure might not reflect benefits on patient-centric outcomes like heart attacks and strokes. It is a surrogate marker.
The story reports: “The rate of side effects was no greater among those who took the three-in-one pill than among the usual care group.”
What were those side effects, how severe were they, and at what rate did they occur? The story doesn’t say.
While the news release doesn’t say what specific side effects were observed, there are array of potential side effects with blood pressure medication that the story could have mentioned, such as nausea and fatigue.
The story is wise to state the findings “should be considered preliminary because research presented at meetings has not undergone the rigorous scrutiny given to research published in medical journals.” It also states that the study involved 700 people with high blood pressure, who averaged 56 years old.
Yet, that wasn’t enough. What kind of study was this? Was it randomized? Blinded? And this is being syndicated by U.S. news outlets — readers should be told that it occurred in Sri Lanka, where there are certainly important differences in the care that would be received compared with the U.S.
There’s no disease-mongering, and the story provides an FDA link to consumer information that includes U.S. high blood pressure prevalence data.
There are no independent sources in the story.
As the story noted, the study compared the combination pill to “usual care.” However, the story doesn’t state what “usual care” means.
The story should have explained what “usual care” meant and whether there were differences in the intensity of therapy between the groups. Maybe the intensity of usual care just needs to be increased.
The story doesn’t explain where or even whether the “triple pill” is available.
The story doesn’t explain how this study fits into the body of research on combination blood pressure pills.
According to the news release, lead researcher Ruth Webster, MBBS, of the George Institute for Global Health at the University of New South Wales, described the study as “the first large trial designed to test the theory that starting treatment with low doses and three drugs could achieve better blood pressure control compared with usual care and that combining these drugs in a single pill would make it easier both for doctors to prescribe treatment and for patients to adhere to it.”
The story is based entirely on information from a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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