• Irbesartan 150mg vs. Irbesartan 37.5mg + bisoprolol 2.5mg + Amplodipine 1.25mg + Indapamide 0.625mg

• First randomised trial that demonstrates that a quarter-dose quadruple combination (quadpill) early in treatment of patients with hypertension is a more effective strategy than initial monotherapy.

• BP levels were lower in the intervention group throughout 12-month follow-up.

• BP control rates were also higher than seen in previous trials of single-pill combinations. Control at <140/90:

  • 6 months: 76%

  • 12 months: 81%

• This is the first trial to demonstrate safety of this strategy, and also that tolerability was maintained, but not improved, against this comparator regimen.

• These findings indicate that a single-pill, quadruple, quarter- dose combination can achieve sustained BP control quickly and safely for the large majority of patients. Initial monotherapy remains the most used strategy globally, and as a result BP control rates remain suboptimal, often due to treatment inertia. This study supports a greater focus by clinicians, medication manufacturers, and consumers on using combination therapy.

• The findings add further weight to the existing trend in guideline recommendations to actively discourage the use of monotherapy while encouraging the greater use of effective and safe combination therapies.

Reference

• 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 (Lancet, 2021)