‘4-in-1’ blood pressure pill shows great promise

Professor Clara Chow, lead and corresponding author and Director of the University of Sydney’s Westmead Applied Research Centre, said in a separate Comment in The Lancet that control of high blood pressure, known as hypertension, was not ideal anywhere, and in some regions such as Africa fewer than one in 10 had hypertension under control. “Statistics on the global burden of high blood pressure this week 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 Chow said. 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 percent. In settings with little or no existing hypertension treatment, the benefits would be much greater.”

The multi-centre, Australian clinical trial of a potential future ‘quadpill’ dose of four medications, termed Quadruple UltrA-low-dose tReatment for hypErTension (QUARTET), has demonstrated that a single pill containing ultra-low quadruple combination is much more effective than the traditional approach of starting with monotherapy (single drug). The study funded by the National Health and Medical Research Council enrolled 591 participants with high blood pressure either in no treatment or  single therapy across 10 centres in Australia. The primary outcome was the significantly reduced blood pressure in the group starting on the quadpill,  at 12 weeks. These differences were sustained, with blood pressure control still better with the quadpill approach compared to the standard approach at 12 months, and no differences in side effects.

Senior author Professor Anthony Rodgers of The George Institute, UNSW Sydney and Imperial College London, said: “Our trial has overwhelmingly demonstrated the efficacy, tolerability and safety of this ultra-low-dose combination strategy – a potentially simple and scalable hypertension management strategy to treat hypertension.” Professor Chow said the study built on their previous study comparing a quadpill approach to placebo. “We aimed to test this new quadpill strategy against usual care in Australia; as is often seen in clinical trials, people in the comparison group got much better treatment than average. Nonetheless our new quadpill strategy was much better,” she said. “This was the first study to show the benefits are maintained long-term without any reduction over time. Even though much more add-on blood pressure medicines were used in the comparison group throughout follow-up, they never caught up with the quadpill group.”