Efficacy, Safety of Low-Dose Combination Triple, Quadruple Treatment for Hypertension

The use of low-dose combination (LDC) with three or four blood pressure (BP) antihypertensives for the management of hypertension is an effective treatment option for patients with the condition, according to a recent study.

Using data sources, such as PubMed and Medline, the researchers conducted a systematic review and meta-analysis of seven trials (n = 1918) that compared LDC consisting of three of four BP-lowering treatments compared to either monotherapy, usual care, or placebo. The primary outcome of the analysis was “mean reduction in systolic BP [SBP] between LDC and monotherapy, usual care, or placebo,” according to the study.

Four out of the seven trials involved the use of triple-component LDC as management, while three out of the seven trials involved quadruple-component LDC. At 4 to 12 weeks follow-up, the researchers found that LDC was associated with a greater mean reduction in SBP when compared to initial monotherapy or usual care (mean reduction [MR] = 7.4 mm Hg; [95% CI, 4.3 - 10.5]) and placebo (MR = 18.0 mm Hg; [95% CI, 15.1 - 20.8]).

Further, the researchers found that there was an association between LDC and a higher proportion of participants achieving BP less than 140/90 mm HG at the follow-up periods, another outcome of interest for the study. The results from two trials used in the analysis indicated that LDC remained superior to monotherapy or usual care at 6 to 12 months.

The only adverse event reported among participants associated with LDC was dizziness, but no other events nor treatment withdrawal were noted.

“The findings in the study showed that LDCs with 3 or 4 antihypertensives were an effective and well-tolerated BP-lowering treatment option for the initial or early management of hypertension,” the researchers concluded.

Reference:

Wang N, Rueter P, Atkins E, et al. Efficacy and safety of low-dose triple and quadruple combination pills vs monotherapy, usual care, or placebo for the initial management of hypertension. JAMA Cardiol. Published online April 26, 2023. doi:10.1001/jamacardio.2023.0720