RCT Results: Does a Single “Quad” Pill for Hypertension Achieve Better BP Control Than Monotherapy?
BACKGROUND AND PURPOSE:
Blood pressure control in patients with hypertension usually requires the use of multiple medications
Chow et al. (The Lancet, 2021) sought to determine whether hypertension management starting with a single pill with 4 medications (i.e., the quadpill) would be more effective than starting therapy with standard dose monotherapy
Mean (SD) age participants: 59 (12) years | 60% male
82% White; 12% Asian; 6% reported other ethnicity
Additional blood pressure medications required by 12 weeks
Quadpill group: 15%
Monotherapy control: 40%
Compared to the control group, the participants receiving the quadpill had
Lower systolic BP
Lower by 6.9 mm Hg (95% CI, 4.9 to 8.9); P<0.0001
Better BP control rates
Monotherapy control: 58%
RR 1.30 (95% CI, 1.15 to 1.47); P<0.0001
Among the 417 patients who continued treatment, up titration occurred more frequently among control participants than participants receiving the quadpill (P<0.0001)
At 52 weeks quadpill recipients still had
Lower mean systolic BP
Lower by 7.7 mm Hg (95% CI, 5.2 to 10.3)
Higher BP control rates
Monotherapy control: 62%
RR 1.32 (95% CI, 1.16 to 1.50)
Serious adverse events up to 12 weeks
Quadpill: 3% (7 events)
Monotherapy control: 1% (3 events)
Hypertension treatment that used a quadpill containing 4 blood pressure medications achieved better BP control than patients started on monotherapy
There was no difference in adverse events
Limitations to this study include not reaching recruitment targets (due to pandemic) which limited comparisons for some secondary and subgroup analyses
The authors state
…this trial has demonstrated the simplicity, tolerability, and effectiveness of a quadpill-based strategy compared with the common strategy of initial standard dose monotherapy. This new paradigm holds promise for achieving better blood pressure control for people with hypertension around the world
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