4 in 1 hypertension treatment more effective than monotherapy

Pharma News: The first large-scale, long-term trial of a new strategy using combinations of very low doses in one capsule, has demonstrated significantly improved control of high blood pressure – the leading cause of heart attack and stroke.

A new strategy where patients are started on a pill containing four medicines, each at a quarter of their usual doses, has been shown to be much more effective in getting blood pressure under control, compared to the common practice of monotherapy, where treatment commences with just one drug and the dose is titrated, as needed.

“Statistics on the global burden of high blood pressure show that there’s been a doubling in the past 30 years of hypertension cases – the leading cause of the world’s top killer: heart attack and stroke,” Professor Clara Chow, lead and corresponding author and Director of the University of Sydney’s Westmead Applied Research Centre.

Traditionally doctors have started with one drug and then follow up to consider adding or changing treatment, but this strategy is often not successful in practice and blood pressure control rates have remained stubbornly low for decades.

Participants in the QUARTET trial were randomly assigned to either treatment, that started with the quadpill – containing Avapro (irbesartan) at 37·5 mg, Norvasc (amlodipine) at 1·25 mg, Natrilix (indapamide) at 0·625 mg, and Bicor (bisoprolol) at 2·5 mg) or a monotherapy control (irbesartan 150 mg).

By 12 weeks, systolic blood pressure was lower by 6·9 mm Hg in the intervention group (p<0·0001) and blood pressure control rates were higher in the intervention group at 76% versus control group at 58% (p<0·0001). 

Dr Emily Atkins from The George Institute for Global Health, UNSW Sydney and the University of Sydney, said “In settings with high levels of specialist care and full access to a range of existing blood pressure medicines – like the centres in this trial – the improved reduction in blood pressure with this strategy would be expected to reduce the risk of heart attacks and strokes by about 20%. In settings with little or no existing hypertension treatment, the benefits would be much greater.”

The results of this Australian study were published in The Lancet and presented at the world-leading European Society of Cardiology conference, ESC Congress 2021.