Low-dose quadruple therapy promising for hypertension management

The mixed-methods process evaluation of the Quadruple Ultra-Low-Dose Treatment for Hypertension USA (QUARTET USA) clinical trial examines the perceptions of patients and healthcare professionals on the use of low-dose quadruple therapy (LDQT) as a novel approach for managing hypertension.

A study published in the Journal of the American Heart Association, JAHA, has concluded that LDQT is well-accepted by patients and healthcare professionals for managing hypertension due to its improved blood pressure control and safety. To achieve LDQT's widespread adoption, stepped-care combinations, treatment protocols, and cost barriers, including insurance coverage and transportation, must be addressed.

A survey was conducted on all 62 patients enrolled in the QUARTET USA trial, and a subsample of 13 patients and 11 healthcare professionals were interviewed. At enrollment, 68% of participants (mean age 51.7 years) reported that their health relied on blood pressure medications, and 48% worried about these medicines.

At the end of the trial, 80% of patients were satisfied with LDQT, 96% felt the benefits of taking LDQT outweighed the drawbacks, and 96% found LDQT to be convenient. Both patients and healthcare professionals found LDQT acceptable because it reduced patients' pill burden and improved medication adherence. Healthcare professionals noted that a limitation of LDQT was the inability to titrate doses. To promote LDQT implementation, steps such as introducing stepped-care combinations and treatment protocols, including it in clinical practice guidelines, and eliminating patient cost barriers can be taken.

Our study is the first to investigate the effectiveness of low-dose quadruple therapy on hypertension control rates in an urban federally qualified health centre network. Treatment satisfaction was high. Scalable interventions are needed to address inequitable blood pressure control rates across diverse contexts. If clinical trial evidence supports the efficacy of low-dose quadruple therapy and patient cost barriers are eliminated, health care professionals would prescribe it, they concluded further.

The major strength of this study is the inclusion of a diverse patient population, they said.

Reference:

Olutobi A. Sanuade et al. Process Evaluation of a Double‐Blind Randomized Controlled Trial to Assess the Efficacy and Safety of a Quadruple Ultra‐Low‐Dose Treatment for Hypertension Within a Federally Qualified Health Center Network (QUARTET USA). Journal of the American Heart Association. 2024;13:e032236