Single-Pill Combination of Four Blood Pressure Medications Outperforms Three-Medication Pill: QUADRO Trial Reveals

New research presented at ESC Congress 2024 reveals that a single pill combining four blood pressure-lowering medications is significantly more effective than a pill with just three medications.

In the QUADRO trial, patients with resistant high blood pressure(18) first went through an 8-week period where they took a combination of three medications—perindopril, indapamide, and amlodipine—at the highest doses they could tolerate.

If their blood pressure remained high after this period (140 mmHg or more at the doctor's office or 130 mmHg or more over 24 hours), and they were following the treatment, they were then randomly assigned to either keep taking the three medications or switch to a single pill that combined perindopril, indapamide, amlodipine, and bisoprolol.

Both groups took the same number of pills daily to keep the study blind. The main measure of success was the change in blood pressure at the doctor’s office, while secondary measures included monitoring blood pressure over 24 hours, at home, and in the office(19).

In the study, 183 patients from 49 centers across 13 countries participated. The average age was 57 years, and 47% were women. Initially, their average office blood pressure was 150.3 mmHg for systolic (top number) and 90.0 mmHg for diastolic(20) (bottom number).

After 8 weeks, patients taking the single-pill combination of four medications saw their average office systolic blood pressure drop by 20.67 mmHg, compared to a drop of 11.32 mmHg for those taking the three-medication combination. The difference was significant, favoring the four-medication pill.

There was also a significant improvement in the average 24-hour ambulatory systolic blood pressure and the office diastolic blood pressure for those on the four-medication pill compared to the three-medication group(21).

Overall, 66.3% of patients on the four-medication pill achieved target blood pressure control, compared to 42.7% of those on the three-medication pill. For normal blood pressure over 24 hours(21), 51.2% of those on the four-medication pill met the target, versus 20.7% of those on the three-medication pill. At home, 60.7% of patients on the four-medication pill achieved normal blood pressure, compared to 25.4% of those on the three-medication pill.

Reference: QUADRO - A single 4-drug combination in hypertension’ will be discussed during Hot Line 2 on Saturday 31 August in room London.