Four-in-one blood pressure pill: Safe and much more effective than usual hypertension treatment, study finds

Date:
August 30, 2021
Source:
University of Sydney
Summary:
The first large-scale, long-term trial of a new strategy using
combinations of very low-doses in one capsule, has demonstrated
significantly improved control of high blood pressure -- the
leading cause of heart attack and stroke.



FULL STORY ==========================================================================
High blood pressure is the world's leading killer but poor rates of
blood pressure control remain common. A new strategy where patients are
started on a pill containing four medicines, each at a quarter of their
usual doses, has been shown to be much more effective in getting blood
pressure under control, compared to the common practice of monotherapy,
where treatment commences with just one drug.


==========================================================================
This first large-scale, randomised controlled clinical trial of starting
this novel combination blood pressure medication brought blood pressure
under control in 80 percent of participants in 12 weeks, compared to
60 percent in the control group who nonetheless had access to the best
patient care.

Traditionally doctors have started with one drug and then follow up to
consider adding or changing treatment -- but this strategy is often not successful in practice and blood pressure control rates have remained stubbornly low for decades.

The results of the Australian study published today in The Lancet and
are being presented at the world-leading European Society of Cardiology conference, ESC Congress 2021.

Professor Clara Chow, lead and corresponding author and Director of
the University of Sydney's Westmead Applied Research Centre, said in
a separate Comment in The Lancet this week that control of high blood
pressure, known as hypertension, was not ideal anywhere, and in some
regions such as Africa fewer than one in 10 had hypertension under
control.

"Statistics on the global burden of high blood pressure this week show
that there's been a doubling in the past 30 years of hypertension cases --
the leading cause of the world's top killer: heart attack and stroke," Professor Chow said.



==========================================================================
Dr Emily Atkins from The George Institute for Global Health, UNSW Sydney
and the University of Sydney said: "In settings with high levels of
specialist care and full access to a range of existing blood pressure
medicines -- like the centres in this trial -- the improved reduction
in blood pressure with this strategy would be expected to reduce the
risk of heart attacks and strokes by about 20 percent. In settings with
little or no existing hypertension treatment, the benefits would be much greater." About the trial The multi-centre, Australian clinical trial of
a potential future 'quadpill' dose of four medications, termed Quadruple UltrA-low-dose tReatment for hypErTension (QUARTET), has demonstrated
that a single pill containing ultra- low quadruple combination is much
more effective than the traditional approach of starting with monotherapy (single drug).

The study funded by the National Health and Medical Research Council
enrolled 591 participants with high blood pressure either in no treatment
or single therapy across 10 centres in Australia. The primary outcome
was the significantly reduced blood pressure, in the group starting on
the quadpill, at 12 weeks. These differences were sustained, with blood pressure control still better with the quadpill approach compared to
the standard approach at 12 months, and no differences in side effects.

Senior author Professor Anthony Rodgers of The George Institute, UNSW
Sydney and Imperial College London, said: "Our trial has overwhelmingly demonstrated the efficacy, tolerability and safety of this ultra-low-dose combination strategy -- a potentially simple and scalable hypertension management strategy to treat hypertension." Professor Chow said the
study built on their previous study comparing a quadpill approach to
placebo. "We aimed to test this new quadpill strategy against usual
care in Australia; as is often seen in clinical trials, people in the comparison group got much better treatment than average. Nonetheless
our new quadpill strategy was much better," she said.



========================================================================== "This was the first study to show the benefits are maintained long-term
without any reduction over time. Even though much more add-on blood
pressure medicines were used in the comparison group throughout follow-up,
they never caught up with the quadpill group." Changing global practice Professor Chow said there were still important research questions. "For
people who may be having side effects from their current treatments,
we would like to know whether a switch to an utra-low-dose combination
can improve things," said Professor Chow.

"Also, the WHO Hypertension Guidelines released this week, just like
other recent hypertension guidelines in Europe, US and elsewhere,
recommend most patients start on two blood pressure drugs rather than
one. We need to know how that would compare to a quadpill strategy."
There is also a major research translation challenge ahead: "These kinds
of strategies will only make a major impact on global health if they are available and affordable for patients most in need," said Professor Chow.

"When we find treatments that are this effective, simple and safe we must
do our best to get them to those who can benefit most." Professor Chow
said a simple and effective combination quadpill strategy had potential to impact people's lives worldwide. "High blood pressure is the leading cause
of preventable deaths globally -- we hope our world-leading findings will
be translated swiftly into a product available for the general public,"
she concluded.

The Lancet paper was led by the University of Sydney's Westmead
Applied Research Centre (WARC) in the Faculty of Medicine and Health,
with co-authors including The George Institute for Global Health, UNSW
Sydney and Imperial College London; University of Western Australia;
University of Tasmania; Western Sydney University, UTS Sydney, Monash University and Curtin University.

WARC was established by the University of Sydney in collaboration with the Western Sydney Local Health District, specifically to address the causes
of chronic disease, with a focus on translational research that addresses
the specific needs and circumstances of patients in western Sydney.

========================================================================== Story Source: Materials provided by University_of_Sydney. Note: Content
may be edited for style and length.


========================================================================== Journal References:
1. Clara K Chow, Emily R Atkins, Graham S Hillis, Mark R Nelson,
Christopher
M Reid, Markus P Schlaich, Peter Hay, Kris Rogers, Laurent
Billot, Michael Burke, John Chalmers, Bruce Neal, Anushka Patel,
Tim Usherwood, Ruth Webster, Anthony Rodgers, Andrew Hung, Armand
Edison, Angalie E Abraham, Daniel Xu, Mark T Bloch, Gemma Figtree,
Janis M Nolde, Andrew Black, Shirley Jansen, Sinjini Biswas,
Andrew E Ajani, Revathy Carnagarin, Dylan Wynne, Mikhail Altman,
Jay Thakkar, Aravinda Thiagalingam, Harry Klimis. 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.

The Lancet, 2021; DOI: 10.1016/S0140-6736(21)01922-X
2. Tu N Nguyen, Clara K Chow. Global and national high blood pressure
burden
and control. The Lancet, 2021; DOI: 10.1016/S0140-6736(21)01688-3 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210829081919.htm

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