Single tablet with 4 BP lowering drugs can be more effective than taking 3 drugs in separate pills: ESC 2024
A single-pill combination of four blood-pressure (BP)-lowering medications was significantly more effective than a combination of three medications, according to late-breaking research presented in a Hot Line session today at ESC Congress 2024.
Explaining why new treatment strategies are needed for hypertension, Principal Investigator, Professor Stefano Taddei from the University of Pisa, Italy, said: “Patients with resistant hypertension on three BP medications, namely a diuretic, a renin-angiotensin system inhibitor and a calcium channel blocker, require the addition of a fourth medication. However, adherence decreases with the number of pills prescribed. In the QUADRO trial, we investigated adding bisoprolol, as part of a single-pill combination of four different BP-lowering medications, and found this was more effective than receiving three BP-lowering medications.”
In the double-blind randomised controlled QUADRO trial, patients with resistant hypertension initially entered an 8-week run-in period where they received the triple combination of perindopril, indapamide and amlodipine at optimal doses (either 10/2.5/5 mg or 10/2.5/10 mg daily, if tolerated). Those who still had uncontrolled BP after 8 weeks (office systolic BP ≥140 mmHg and 24-hour ambulatory systolic BP ≥130 mmHg), while being adherent to the therapy, were randomised 1:1 to either continue the same triple therapy or to receive a single-pill combination containing perindopril, indapamide, amlodipine and bisoprolol (at either 10/2.5/5/5 mg or 10/2.5/10/5 mg daily) for 8 weeks. To preserve the blinding, patients in the two groups received the same number of pills every day: two capsules and one tablet. The primary endpoint was the change in office systolic BP. Secondary endpoints included 24-hour ambulatory BP monitoring, office diastolic BP, home BP and BP control.
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