Efficacy and Safety of GMRx2 Compared to Placebo for the Treatment of Hypertension

NCT ID: NCT04518306

Last Updated: 2025-06-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 755 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-06-14
• Study Completion Date: 2023-10-18

Brief Summary

Recent hypertension guidelines recommend combination therapy as initial treatment for many or most patients. Several trials suggest triple low-dose combination therapy may be highly effective in terms of achieving blood pressure control without increasing adverse effects. This trial is designed to investigate the efficacy and safety of GMRx2 in participants with high blood pressure compared to placebo.

Detailed Description

TRIAL DRUG:

GMRx2: single pill combination of telmisartan/amlodipine/indapamide Dose version 1: telmisartan 10 mg/amlodipine 1.25 mg/indapamide 0.625 mg Dose version 2: telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg INDICATION: Hypertension

TRIAL TITLE:

Efficacy and safety of GMRx2 compared to placebo for the treatment of hypertension.

OBJECTIVES:

To investigate the efficacy and safety of GMRx2 compared to placebo for the treatment of hypertension.

INTERVENTION:

A 2-week single-blind placebo run-in will be followed by a 4-week double-blind period with randomization to GMRx2 dose version 1, GMRx2 dose version 2 or placebo.

Conditions

Hypertension

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Triple ¼ (GMRx2)

Telmisartan 10 mg/amlodipine 1.25 mg/indapamide 0.625 mg

Group Type: EXPERIMENTAL

Telmisartan 10 mg/amlodipine 1.25 mg/indapamide 0.625 mg

Intervention Type: DRUG

Oral tablets

Triple ½ (GMRx2)

Telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg

Group Type: ACTIVE_COMPARATOR

Telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg

Intervention Type: DRUG

Oral tablets

Placebo

Placebo

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

Placebo

Interventions

Telmisartan 10 mg/amlodipine 1.25 mg/indapamide 0.625 mg

Oral tablets

Intervention Type: DRUG

Telmisartan 20 mg/amlodipine 2.5 mg/indapamide 1.25 mg

Oral tablets

Intervention Type: DRUG

Placebo

Placebo

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

At screening visit:

1. Provided signed consent to participate in the trial.

2. Adult aged ≥18 years.

3. Low calculated CV risk according to local guidelines such that pharmacological BP-lowering treatment is not mandatory: e.g. Pooled Cohorts Equation 10-years ASCVD risk <10% in the USA.

4. Likely diagnosis of hypertension, defined as one or more of:

• automated SBP at this clinic visit according to trial methods (see Appendix 2) of ≥130mmHg on no BP lowering medicines or ≥120mmHg on 1 BP lowering medicine that will be stopped at this visit, OR
• documentation in last 6 months of office SBP ≥ 140 mmHg and/or DBP ≥ 90mmHg on no BP lowering medicines or SBP ≥ 130 mmHg and/or DBP ≥ 85mmHg on 1 BP lowering medicine that will be stopped at this visit, OR
• documentation in last 6 months of home SBP ≥ 130 mmHg and/or DBP ≥ 80mmHg on no BP lowering medicines or SBP ≥ 120 mmHg and/or DBP ≥ 75mmHg on 1 BP lowering medicine that will be stopped at this visit, OR
• documentation in last 6 months of ambulatory daytime SBP ≥ 130 mmHg and/or DBP ≥ 80mmHg on no BP lowering medicines or SBP ≥ 120 mmHg and/or DBP ≥ 75mmHg on 1 BP lowering medicine that will be stopped at this visit

5. No contraindication to trial medications, including 2-weeks placebo run-in and 4-weeks randomized treatment period with GMRx2 (dose version 1 or 2) or placebo.

At randomization visit:

1. Home seated mean SBP 130-154 mmHg in the week before the randomization visit.

2. Adherence of 80-120% to placebo run-in.

3. Tolerated placebo run-in.

4. Adherence to home BP monitoring schedule: in the week before randomization, at least 6 measures (e.g. ≥2 sets of triplicate measures) including at least 1 morning and 1 evening each with ≥2 measures. Morning is defined as any measure in the am and evening as any measure in the pm. Morning and evening do not have to be same day.

Exclusion Criteria

At screening visit:

1. Receiving 2 or more BP-lowering drugs.

2. Clinic seated mean SBP ≥160 mmHg and/or DBP ≥100 mmHg.

3. Pregnant or had a positive pregnancy test or unwilling to undertake a pregnancy test during the trial and up to 30 days after the discontinuation of the trial medication or breastfeeding or of childbearing age and not using an acceptable method of contraception. Acceptable methods of birth control include hormonal prescription oral contraceptives, contraceptive injections, contraceptive patch, intrauterine device, double-barrier method (e.g. condoms, diaphragm, or cervical cap with spermicidal foam, cream, or gel), or male partner sterilization. Contraception should be used for at least 1 month before the screening visit and until the end of trial participation.

4. Not suitable for participation in a clinical trial according to local ethical or regulatory requirements related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

5. Contraindication, including hypersensitivity (e.g. anaphylaxis or angioedema), to any of the 3 trial medications.

6. Current/history of transient ischemic attack, stroke, or hypertensive encephalopathy.

7. Current/history of acute coronary syndrome, unstable angina, myocardial infarction, percutaneous transluminal coronary revascularization, or coronary artery bypass graft.

8. Current/history of New York Heart Association class III and IV congestive heart failure.

9. Current/history of a known secondary cause of hypertension, such as primary aldosteronism, renal artery stenosis, pheochromocytoma, or Cushing's syndrome.

10. Current/history of substantially uncontrolled diabetes (HbA1c > 11.0%) within last three months.

11. Current/history of end-stage renal disease or anuria or estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2.

12. Current/history of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >3 times the upper limit of normal range within 6 months.

13. Current concomitant illness or physical impairment or mental condition that in the judgment of the investigator could interfere with the effective conduct of the trial or constitutes a significant risk to the participants' well-being.

14. Arm circumference that is too large (>55 cm) or too small (<20 cm) to allow accurate measurement of BP.

15. Currently taking or might need during the trial, a concomitant treatment which is known to interact significantly with the trial medication: digoxin, lithium, diabetics receiving aliskiren, moderate and strong CYP3A4 inhibitors [e.g. ritonavir, ketoconazole, diltiazem], simvastatin >20 mg/day, immunosuppressants.

16. Might need treatment with drugs that are prohibited during the trial: other antihypertensive drugs, endothelin receptor antagonists, neprilysin inhibitors, or other drugs that may affect BP (see Error! Reference source not found.).

17. Current surgical or medical condition that might significantly alter the absorption, distribution, metabolism, or excretion of trial drugs such as prior major gastrointestinal tract surgery (e.g. gastrectomy, lap band, or bowel resection) or acute flare of inflammatory bowel disease within one year.

18. Individuals working >2-night shifts per week.

19. Participated in any investigational drug or device trial within the previous 30 days.

20. History of alcohol or drug abuse within 12 months.

At randomization visit:

1. Unable to adhere to the trial procedures during the run-in period.

2. Any of the following which in the investigator's judgment may compromise the safety of the participant if randomized to the trial medications:

1. High or low clinic BP levels even in the light of the values for home BP that are available for that participant. The exact levels of BP are not specified, since there is clinical uncertainty as to the relevance of BP levels which are high/low in clinic only; for example the clinical relevance of 'whitecoat hypertension' is uncertain.

2. High or low home DBP levels. The exact levels of DBP are not specified, reflecting clinical uncertainty of for example isolated diastolic hypertension. However, home DBP values of >99 mmHg may typically be considered as requiring treatment intensification, and such participants would not be suitable for randomization.

3. Any abnormal laboratory value which in the judgment of the investigator could interfere with the effective conduct of the trial or constitutes a significant risk to the participants' well-being.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

George Medicines PTY Limited

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Anthony Rodgers, Professor

Role: PRINCIPAL_INVESTIGATOR

The George Institute

Locations

Elite Clinical Studies

Phoenix, Arizona, United States

Headlands Research

Scottsdale, Arizona, United States

Quality of Life Medical & Research Centers, LLC

Tucson, Arizona, United States

Valiance Clinical Research

South Gate, California, United States

Valiance Clinical Research

Tarzana, California, United States

Clinical Research of Brandon

Brandon, Florida, United States

Inpatient Research Clinic

Hialeah, Florida, United States

Suncoast Research Group

Miami, Florida, United States

New Horizon Research Center

Miami, Florida, United States

Ocala Research Institute

Ocala, Florida, United States

Altus Research, Inc

Palm Beach, Florida, United States

Suncoast Research Associates

St. Petersburg, Florida, United States

Accel Research

St. Petersburg, Florida, United States

Precision Clinical Research

Sunrise, Florida, United States

Precision Research Center

Tampa, Florida, United States

Buckhead Primary Care Research

Snellville, Georgia, United States

Meridian Clinical Research

Baton Rouge, Louisiana, United States

The University of Tennessee Health Science Center

Memphis, Tennessee, United States

Synergy Groups Medical

Houston, Texas, United States

Synergy Groups Medical

Houston, Texas, United States

Synergy Groups Medical

Missouri City, Texas, United States

North Hills Medical Research

North Richland Hills, Texas, United States

Meridian Clinical Research

Portsmouth, Virginia, United States

Castle Hill Medical Centre

Castle Hill, New South Wales, Australia

Hudson Institute of Medical Research

Clayton, Victoria, Australia

Barwon Health, Geelong University Hospital

Geelong, Victoria, Australia

Curtin University

Bentley, Western Australia, Australia

Royal Perth Hospital

Perth, Western Australia, Australia

University of Abuja Teaching Hospital

Gwagwalada, Federal Capital Territory, Nigeria

Aminu Kano Teaching Hospital

Kano, , Nigeria

Institute of Cardiology, National Hospital of Sri Lanka

Colombo, , Sri Lanka

Colombo South Teaching Hospital

Dehiwala, , Sri Lanka

Karapitiya Teaching Hospital

Galle, , Sri Lanka

Jafna Teaching Hospital

Jaffna, , Sri Lanka

Kandy National Hospital

Kandy, , Sri Lanka

Kurunegala Teaching Hospital

Kurunegala, , Sri Lanka

Colombo North Teaching Hospital

Ragama, , Sri Lanka

Steploe Medical Centre

Soham, Cambridgeshire, United Kingdom

Newquay Medical

Newquay, Cornwall, United Kingdom

Burbage Surgery

Hinckley, Leicestershire, United Kingdom

Belmont Health Centre

Harrow, London, United Kingdom

West Walk Surgery

Bristol, Somerset, United Kingdom

Brockwood Medical Practice

Betchworth, Surrey, United Kingdom

Lakeside Surgery

Coventry, West Midlands, United Kingdom

Trowbridge Health Centre

Trowbridge, Wiltshire, United Kingdom

Abbeywell Surgery

Romsey, , United Kingdom

Albany House Medical Centre

Wellingborough, , United Kingdom

Countries

United States; Australia; Nigeria; Sri Lanka; United Kingdom

References

Rodgers A, Salam A, Schutte AE, Cushman WC, de Silva HA, Di Tanna GL, Grobbee D, Narkiewicz K, Ojji DB, Poulter NR, Schlaich MP, Oparil S, Spiering W, Williams B, Wright JT Jr, Gutierez A, Sanni A, Lakshman P, McMullen D, Ranasinghe G, Gianacas C, Shanthakumar M, Liu X, Wang N, Whelton P. Efficacy and Safety of a Novel Low-Dose Triple Single-Pill Combination Compared With Placebo for Initial Treatment of Hypertension. J Am Coll Cardiol. 2024 Dec 10;84(24):2393-2403. doi: 10.1016/j.jacc.2024.08.025. Epub 2024 Aug 31.

Reference Type: DERIVED

PMID: 39217570 (View on PubMed)

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

GMRx2-HTN-2020-PCT1

Identifier Type: -

Identifier Source: org_study_id