Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review

Publication date: Available online 10 February 2017 Source:The Lancet Author(s): Clara K Chow, Jay Thakkar, Alex Bennett, Graham Hillis, Michael Burke, Tim Usherwood, Kha Vo, Kris Rogers, Emily Atkins, Ruth Webster, Michael Chou, Hakim-Moulay Dehbi, Abdul Salam, Anushka Patel, Bruce Neal, David Peiris, Henry Krum, John Chalmers, Mark Nelson, Christopher M Reid, Mark Woodward, Sarah Hilmer, Simon Thom, Anthony Rodgers Background Globally, most patients with hypertension are treated with monotherapy, and control rates are poor because monotherapy only reduces blood pressure by around 9/5 mm Hg on average. There is a pressing need for blood pressure-control strategies with improved efficacy and tolerability. We aimed to assess whether ultra-low-dose combination therapy could meet these needs. Methods We did a randomised, placebo-controlled, double-blind, crossover trial of a quadpill—a single capsule containing four blood pressure-lowering drugs each at quarter-dose (irbesartan 37·5 mg, amlodipine 1·25 mg, hydrochlorothiazide 6·25 mg, and atenolol 12·5 mg). Participants with untreated hypertension were enrolled from four centres in the community of western Sydney, NSW, Australia, mainly by general practitioners. Participants were randomly allocated by computer to either the quadpill or matching placebo for 4 weeks; this treatment was followed by a 2-week washout, then the other study treatment was administered for 4 weeks. Study staff and partici...
Source: The Lancet - Category: Journals (General) Source Type: research