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4-in-1 Blood Pressure Pill Could Improve Outcomes

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Sept. 1, 2021 (HealthDay News) -- A four-in-one pill containing "ultra-low doses" of different medications can provide better blood pressure control than standard drug treatment, a new clinical trial from Australia shows.

Research found that about 80% of those who received the "quadpill," achieved healthy blood pressure levels of 140/90 and above within 3 months, with continued improvement for up to one year. That compares to 66% of patients who were prescribed only one drug and had to add others to their regimen as they needed.

Professor Clara Chow of the University of Sydney, the lead researcher said that starting with a very low dose combination of blood pressure medications was better than taking one full-dose medication and gradually adding other medicines to increase blood pressure control.

Chow explained that the 12-month catch-up was not possible. The quadpill group still maintained better blood pressure control, despite most people still being on the same four-in-one pills.

According to Dr. Eugene Yang (chair of the American College of Cardiology’s Prevention of Cardiovascular Disease Section), some blood pressure guidelines recommend that you take a combination of several pills in order to reach healthier levels.

Yang, who is the medical director of University of Washington Medicine Eastside Specialty Center (Bellevue), said that people may be more likely to stick to their medication if they combine these various medications.

Yang explained that this strategy helps improve compliance because it is known that taking more pills can lead to lower adherence.

Four different tried-and-tested blood pressure medications were combined into one pill and randomly prescribed to half of a group of nearly 600 Australians, to test for safety and effectiveness.

Chow, along with her coworkers, figured that there would be fewer side effects because each of the medications in this pill was only a quarter what is normally prescribed.

Chow stated that a quarter of the blood pressure medicines isn't as effective as a full dose, but it can be as high as 60%. When four quarter doses are combined, you get the greatest effect at the lowest dosage.

They were right as the side effects of quadpills had been very mild in this group.

The side effects associated with any medications taken at extremely low doses would be very small. The majority of side effects can be attributed to dose, which is why these ultra-low doses are used," stated Dr. Robert Carey who was dean emeritus of University of Virginia School of Medicine. Carey also co-authored the American Heart Association blood pressure treatment guidelines.

Three weeks later, the mean blood pressure for the quadpill-treated group was 120/71. It was 127/79 for the control group.

The findings were published Aug. 29 in The Lancet journal and was also presented virtually last week at the European Society of Cardiology meeting.

Carey stated that such a quadpill is most beneficial to countries in developing and rural areas of the United States, where access to healthcare services is limited.

Carey stated that in such locations, it is difficult to determine blood pressure either at home or at work, as well as to adjust and add medication doses.

Chow explained that although there aren't any big-scale companies that manufacture this combination of low-dose tri-triple medications, they have to consider the research evidence. Chow stated that combining blood pressure medication in combination with low levels of other medications is far better for blood pressure control. This allows blood pressure to be controlled quickly and safely.

Yang expressed satisfaction with the trial's results, but he would like to see more clinical trials that treat people with high blood pressures. Yang noted that the average blood pressure for trial participants was 141/85. The study was designed to help people with blood pressures below 140/90.

Yang explained that the trial participants didn't begin at a level where they had to accomplish this goal.

Yang would like to see future research that examines whether lower blood pressure can prevent life-threatening diseases.

Yang explained that the real question is whether these interventions provide any significant benefit such as heart attacks, strokes, and heart failure prevention.

More information

The American Heart Association has more about high blood pressure.

SOURCES: Clara Chow, MBBS, PhD, professor, medicine, University of Sydney, Australia; Eugene Yang, MD, medical director, University of Washington Medicine Eastside Specialty Center, Bellevue; Robert Carey, MD, dean emeritus, University of Virginia School of Medicine; The Lancet, Aug. 29, 2021