Randomised controlled decentralised feasibility trial of a fixed low-dose combination antihypertensive drug strategy to attenuate cognitive decline in high-risk adults.

Objectives: The Action To promote brain HEalth iN Adults study aimed to determine the feasibility and applicability of recruitment using home blood pressure (BP) monitoring, routine blood biochemistry and videoconference measures of cognition, in adults at high risk of dementia.
Design: A decentralised double-blind, placebo-controlled, randomised feasibility trial with a four-stage screening process.
Setting: Conducted with participants online in the state of New South Wales, Australia.
Participants: Participants were aged 50-70 years with moderately elevated BP (systolic >120 and <160 mm Hg or diastolic >80 and <95 mm Hg) and ≥1 additional enrichment risk factor of monotherapy treatment of hypertension, diabetes mellitus, elevated low-density lipoprotein cholesterol, obesity, current smoking or a first degree relative with dementia, which indicated an elevated risk for future cognitive decline.
Intervention: Triple Pill (active antihypertensive treatment of telmisartan 20 mg, amlodipine 2.5 mg and indapamide 1.25 mg) or placebo Triple Pill (blinded study capsules).
Primary and Secondary Outcome Measures: Primary outcome was feasibility of the study expressed as the percentage of participants randomised from those who were screened. Secondary outcomes were the applicability of videoconference measures of cognition and the overall trial, tolerability of the Triple Pill, safety outcomes and medication adherence.
Results: The proportion (95% CI) of patients randomised to those screened was 5% (2%-10%). The applicability of the trial expressed as percentage of those who completed all remote assessments over the number of randomised participants was 67% (95% CI 05 to 22%). There were no serious adverse events or withdrawals from treatment. All participants adhered to study medication, except for one person who had two capsules left at the end of the study period.
Conclusions: The feasibility of this decentralised trial on BP lowering in patients at high risk for dementia is low. However, the applicability of remote assessments of cognitive function is acceptable.
Trial Registration Number: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000121864.
Competing Interests: Competing interests: JC, RL, CSA report research grants from the NHMRC for the 'Triple therapy prevention of Recurrent Intracerebral Disease EveNts Trial' (TRIDENT) trial (APP1103886, APP1149987). CC is supported by the Australian Heart Foundation Postdoctoral Fellowship (102741) and an Australian National Health and Medical Research Council (NHMRC) Investigator Grant, Emerging Leadership 1 (APP2009726) and receives research support from Bayer. CMH is supported by the National Heart Foundation Future Leader Fellowship. JC and AL are supported by the NHMRC Program Grant (APP9149987). MW is supported by an NHMRC Investigator Grant, (APP1174120), Program Grant (APP1149987) and reports consultancies for Amgen and Freeline. SLN is supported by an NHMRC Leadership Fellowship 2008064 and has received consulting fees from Roche, Nutrica and Eisai. CSA reports research grants from Penumbra and Takeda paid to his institution, and he is Editor-in-Chief of Cerebrovascular Diseases and Vice-President of the World Stroke Organisation.
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