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

Abstract

35Background: There is a pressing need for blood pressure control strategies with improved efficacy and 36 tolerability. We examine whether using ultra-low dose quadruple combination therapy provides an 37 approach with greater efficacy and tolerability. 38

Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice

“…In this respect, clinical trials have shown that adequate blood pressure control is possible with combinations of up to four antihypertensive drugs [2][3][4]. American and European guidelines for the treatment of hypertension suggest [5,6], as initial therapy, the option of a combination of two antihypertensive drugs to achieve better control and, if hypertension remains uncontrolled, the addition of a third antihypertensive drug is recommended [5].…”

Assessment and treatment of resistant hypertension

“…There has been recent interest in using very small (quarter) doses of four antihypertensive agents in a single capsule (called a Quadpill) in an attempt to improve adherence by reducing pill burden and reducing adverse effects because of the very low doses used . The drugs included in the capsule were irbesartan 37.5mg, amlodipine 1.25mg, hydrochlorothiazide 6.25mg and atenolol 12.5mg.…”

Nephro Update Europe 2018

“…A meta-analysis by Chow et al [27] of 354 trials considered the drug dosage. Results showed that half of the standard dose (the recommendation to reach blood pressure targets) achieved almost 80% of the blood pressure-lowering effect.…”