The Lancet: Quadruple medicine is more effective in controlling high blood pressure

Hypertension is known as the "silent killer", its symptoms are not obvious, but it can significantly increase the risk of heart disease and stroke
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When treating hypertension, doctors’ traditional approach is to first use a drug, and then continue to consider adding or changing the treatment plan, but this strategy is often unsuccessful in practice, and the rate of blood pressure control has remained high for decades
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Australian researchers have recently proposed a new treatment strategy: patients take a single drug containing four drugs, and the dose of each drug is one-fourth of its usual dose
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In the first large-scale randomized controlled clinical trial using this new combination antihypertensive drug, 80% of participants' blood pressure was controlled within 12 weeks, while only 60% of participants in the control group received good patient care
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Professor Clara Chow, director of the Westmead Center for Applied Research at the University of Sydney and corresponding author, said in another review in The Lancet that the control of high blood pressure is not ideal anywhere
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"Statistics on the global burden of high blood pressure this week show that the number of cases of high blood pressure has doubled in the past three decades
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Clinical trials of quadruple drugs

Australia has recently launched a multi-center clinical trial called the Quadruple Ultra-Low Dose Hypertension Therapy (QUARTET) trial
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The trial enrolled 591 hypertensive patients in 10 centers in Australia.

Senior author, Professor Anthony Rodgers of the University of New South Wales in Sydney, said: "Our trial has overwhelmingly demonstrated the effectiveness, tolerability and safety of this ultra-low-dose combination strategy, showing that it is a simple And scalable hypertension treatment strategy
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Professor Chow said: “This is the first study to show that this benefit can be maintained for a long time without diminishing over time
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Although the control group used more antihypertensive drugs throughout the follow-up process, they never Catch up with the quadruple medication group
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Changing global practices

Professor Chow said that there are still some important research issues
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"For patients who may have side effects due to current treatments, we want to know whether switching to an ultra-low-dose combination can improve the situation," she said
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"In addition, just like the recent hypertension guidelines issued in Europe, the United States and elsewhere, the hypertension guidelines issued by the WHO this week also recommend that most patients take two antihypertensive drugs at the beginning instead of one
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We need Know how this is different from the quadruple drug strategy
.
"

There are also major research translation challenges in the future: "These strategies will have a significant impact on global health only when the patients most in need can access and can afford them," said Professor Chow
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"When we find such effective, simple and safe treatments, we must do our best to provide them to those who can benefit the most
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She said that this simple and effective quadruple drug strategy may affect the lives of patients around the world
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"High blood pressure is the leading cause of preventable deaths worldwide-we hope that this leading research result can be quickly translated into a product that can be used by the public
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"

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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

DOI: https://doi.
org/10.
1016/S0140-6736(21)01922-X