A RECENT study presented at the ESC Congress 2024 has found that a single tablet containing four blood pressure-lowering drugs is significantly more effective than a combination of three separate medications for patients with resistant hypertension. The study is a promising approach to improving blood pressure (BP) control in patients struggling with medication adherence.
The QUADRO trial explored the impact of adding bisoprolol to a three-drug regimen in a single-pill combination. The trial’s lead investigator, Professor Stefano Taddei from the University of Pisa, Italy, emphasised the need for new treatment strategies, noting that adherence to BP medication declines as the number of pills increases.
In the double-blind, randomised controlled trial, 183 patients from 49 centres across 13 countries were initially treated with a three-drug combination: perindopril, indapamide, and amlodipine. Those whose BP remained uncontrolled were randomised to continue their current treatment or switch to a single-pill combination that included the fourth drug, bisoprolol.
Results showed a significant reduction in systolic BP for the group taking the quadruple single-pill combination compared to those on the three-drug regimen. Specifically, mean office systolic BP decreased by 20.67 mmHg in the quadruple group, versus 11.32 mmHg in the triple group. BP control was achieved in 66.3% of patients on the quadruple pill compared to 42.7% on the triple therapy.
The study found no significant differences in adverse events between the two groups, suggesting the quadruple single-pill combination is both effective and safe. Taddei concluded that this approach could significantly improve adherence and BP control for patients with resistant or difficult-to-treat hypertension.
Aleksandra Zurowska, EMJ
Reference
Lawson A J et al. Nonadherence to antihypertensive medications is related to pill burden in apparent treatment-resistant hypertensive individuals. J Hypertens. 2020;38:1165-73.
