Abstract
Objective: The objective of the study was to compare the clinical and economic effectiveness of four combination antihypertensives recommended for Nigerians.
 Methods: An open, randomized, controlled, and longitudinal double-blind trial of four groups of antihypertensives combinations: Telmisartan/ chlorthalidone/amlodipine (TCA), TC, CA, and TA was conducted among hypertensive patients. The participants were recruited from three hospitals in Enugu, and randomly assigned to the study groups. The primary outcome for this study was blood pressure (BP) control, based on Joint National Committee-8 and cost per BP control. The secondary outcomes were cost per quality adjusted life years (QALY) and patients’ self-reported health status. Descriptive and inferential statistics were used for statistical analysis.
 Results: Of the 110 patients enrolled in the study, more than half were women (55.5%). The mean age of patients was 54.93±12.38. The enrollees had hypertension for over 9 years (9.17±8.40). About 77% of the patients completed the study in all the groups except for TA (66.7%). There was no difference in BP in all the groups at baseline and at end-of-study (p>0.050). However, the probability of BP control was highest in TCA group (0.37±0.01), followed by TC group (0.23±0.02). The TA group showed the most favorable cost per QALY, then CA, TC, and TCA in that order. The group with the most favorable cost per BP control was TCA (70.92±0.04), then TA (94.16±0.05).
 Conclusion: The triple combination therapy of TCA had the best cost per BP control in the management of hypertensive patients. It demonstrated the highest probability of BP control.
Highlights
Hypertension is still a global public health problem, and the financial cost associated with the disease continues to increase
Out of the 110 patients enrolled in the study, more than half were women (55.5%)
The results showed that patients’ reported health status indices (EQVAS and EQ-5D index scores) were highest for CA group, followed by Telmisartan/ chlorthalidone/amlodipine (TCA) group
Summary
Hypertension is still a global public health problem, and the financial cost associated with the disease continues to increase. Hypertension is a major risk factor for the development of other cardiovascular diseases such as heart failure, stroke, and ischemic heart disease [2]. It is one of the leading causes of morbidity and mortality due to cardiovascular complications [3,4]. In 2014, hypertension prevalence in Nigeria was estimated at 28.9% by the World Health Organization. In 2030, it is projected that the country will record 39.1 million cases of hypertension among its adult population, with a prevalence of 30.8% [5,6]. Treatment and control of hypertension are low in Nigeria and other countries in SSA. A study reported that only 25.4% of patients attending a hypertension clinic in a tertiary hospital achieved desired blood pressure (BP) control [8]
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