24-MONTH SINGLE-PILL, TRIPLE ANTIHYPERTENSIVE THERAPY IN RURAL RWANDA

Objective: Arterial hypertension is a major issue in Sub-Saharan Africa, affecting both urban and rural populations, regardless of body weight. This report includes data from 57 out of 79 rural Rwandese patients (mean BMI 21.4 kg/m2) who continued a once-daily triple combination of amlodipine, hydrochlorothiazide, and olmesartan for 24-month. Design and method: Hypertensive individuals were identified through a house-to-house screening in Nyaruguru, a rural district in Southern Rwanda (Ethics Approval: 752/RNEC/2019). BP was measured according to European Society of Hypertension guidelines using a validated, automated, oscillometric OMRON M7 IT-HEM-7322-E monitor. The once-daily triple-combination pill, provided free, was adjusted based on BP readings and clinical evaluations at each visit (Figure). Results:Of the 57 individuals, 77% were female, and 91% had a BMI below 25.0 kg/m2(Table 1). Systolic and diastolic BP dropped significantly (P<0.001) by 29 [25-38]/12 [6-21] mmHg in the first month, with further reductions of 11 [4-21]/5 [0-12] mmHg by month 3, stabilizing thereafter. At 24 months, BP was lower by 32 [21-43]/14 [9-21] mmHg compared to baseline. BP normalization occurred in 65% of cases by month 1, 89% by month 3, and 83% by month 24. Heart rate decreased significantly (P<0.001) by 6 [0-16] bpm at 12 months and 7 [0-17] bpm at 24 months. Drug tolerance was excellent, with no treatment-related withdrawals, except for dizziness in two cases. Similar results in terms of improved blood pressure control and tolerability, compared to standard care, were obtained in three Nigerian clinics with 300 urban hypertensive patients (mean BMI 28 kg/m2) put on a 6-month single-pill regimen of amlodipine, indapamide, and telmisartan. Conclusions: In both settings, a single-pill combination of calcium channel blocker, thiazide diuretic, and angiotensin II receptor antagonist achieved around 80% BP control with excellent tolerability over 6 and 24 months, respectively. BP improvement was observed within one month, peaking by two months. These findings highlight combination therapy as a first-line treatment in Africa, where simplified, effective hypertension management is a priority. Key challenges include ensuring medication availability, affordability, and integration into primary care, requiring solutions to structural, regulatory, pricing, and workforce barriers.