Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial

Treating hypertension with a pill containing very low doses of four antihypertensive agents compared with standard dose irbesartan

“…This multicentre double-blind randomised trial showed that initial treatment with daily dosing of a single combination pill containing four medicines at a quarter of their standard dose (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg) resulted in faster and greater blood pressure (BP) reduction with higher rates of BP control compared with monotherapy with irbesartan 150 mg/day in 591 hypertensive individuals over a 12-week and 52-week period. At 52 weeks, the number of serious adverse events was similar in both groups 1…”

“…This Australian multicentre, double-blind, active control, randomised trial compared a once-daily single pill containing low doses of four antihypertensive medicines with monotherapy using irbesartan 150 mg/day for 12 weeks for people with hypertension 1. The quadpill contained irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg and was formulated to appear identical to irbesartan monotherapy.…”

Strategies to support early- and mid-career cardiovascular researchers to thrive

“…Seed funding from the National Heart Foundation of Australia was essential for the initial feasibility studies of the quadpill, now confirmed to achieve better blood pressure control than monotherapy in a landmark clinical trial. 9 Another example includes the discovery of new mechanisms of blood pressure regulation in pre-clinical models, 10 which was supported by seed funding from the Foundation for High Blood Pressure Research, and now has led to a randomised clinical trial. 11 Existing funding schemes could be redesigned to require EMCR leadership and allow recognition of EMCRs as main/equal chief investigators.…”

Long-Term Secondary Prevention: Management of Blood Pressure After a Transient Ischemic Attack or Stroke

“…Although improved treatment adherence to a less complex regimen might be a benefit of using a polypill after TIA/stroke, this could be offset by higher rates of adverse events, even if these have not been encountered in nongeneralizable healthy trial populations. 95 Many polypills have included ACE inhibitors and β-adrenergic antagonists, 96 which may increase BP variability 97 and would be inappropriate for those with bradykinin-induced cough or previously diagnosed asthma, respectively, both present in at least 4% of this population. [98][99][100] Although thiazide/thiazide-like diuretics are highly effective for secondary stroke prevention, 73 so would likely be included in any polypill designed for this population, they are associated with the highest rates of discontinuation due to their side-effect profiles, particularly electrolyte disturbances in older patients.…”