perindopril + indapamide + amlodipine + olmesartan + amlodipine + hydrochlorothiazide

This combination refers to the antihypertensive agents utilized in the OPTIMAL-HT clinical trial (NCT04141540), conducted by the National Institute of Cardiology in Warsaw, Poland. The study evaluates the effectiveness of two different triple single-pill combinations (SPCs)—either perindopril/indapamide/amlodipine or olmesartan/amlodipine/hydrochlorothiazide—as a baseline therapy for patients under 65 with difficult-to-treat hypertension. The trial further investigates the addition of a fourth drug (spironolactone, eplerenone, or torasemide) to these triple regimens to achieve the blood pressure targets defined by the ESC/ESH guidelines (120-129/70-79 mmHg). The components include an ACE inhibitor (perindopril), an angiotensin II receptor blocker (olmesartan), calcium channel blockers (amlodipine), and diuretics (indapamide and hydrochlorothiazide). Together, these agents provide comprehensive blood pressure control by targeting the renin-angiotensin-aldosterone system, vascular smooth muscle contraction, and renal sodium reabsorption.