By Dennis Thompson
HealthDay reporter
WEDNESDAY, September 1, 2021 (HealthDay News) – A four-in-one pill containing “ultra-low doses” of various drugs may provide better blood pressure control than standard drug treatment, a new clinical study from Australia shows .
Approximately 80% of people given the “quad pill” achieved healthy blood pressure of 140/90 within three months and up to a year, compared with 60% of people who started on a single drug and added more as needed , reported researchers.
“Starting out on this very low-dose combination of blood pressure medication was more effective than the usual approach of starting a full dose medication and then gradually adding medication to improve blood pressure control,” said lead researcher Dr. Clara Chow, Professor of Medicine at the University of Sydney.
“And even after 12 months there was no catching up – that is, the group that started the quad pill still had better blood pressure control after 12 months,” with most of them still only having the only four-in-one Taking the pill. Chow continued.
Some guidelines for blood pressure management already recommend using combinations of different pills to better achieve healthy levels, said Dr. Eugene Yang, chairman of the Cardiovascular Disease Prevention Section of the American College of Cardiology.
Combining these different drugs into one pill could help people get through their treatment better, said Yang, medical director of the Eastside Specialty Center at the University of Washington Medicine at Bellevue.
“A lot of what drives this strategy is improving adherence because we know the more pills you take, the less adherence there is,” said Yang.
Four different proven blood pressure drugs were combined in one pill and randomly prescribed to half a group of nearly 600 Australians to test their safety and effectiveness.
Chow and her colleagues found that the likelihood of side effects would be less since each drug in the pill would be a quarter of the amount normally prescribed.
“A quarter dose of any blood pressure drug isn’t a quarter as effective; in fact, it’s closer to 60% as effective,” Chow explained, meaning they were synergistic. So when combined, four quarter doses give you the maximum effect with the minimum dose. “
Her suspicions were correct as there were few serious side effects in the group taking the quad pill.
“The side effects of any of these drugs at the ultra-low dose would be extremely minor. Side effects are almost always dose-dependent, and these are ultra-low doses,” said Dr. Robert Carey, Dean Emeritus of the University of Virginia School of Medicine and co-author of the American Heart Association’s Blood Pressure Treatment Guidelines.
After three weeks, the mean blood pressure in the quad pill group was 120/71 compared to 127/79 in the standard care group.
The results were published in The Lancet on August 29th and were also presented in practice last week at the meeting of the European Society of Cardiology.
Carey said such a quad pill would be of greatest benefit to developing countries and remote parts of the United States where there is less access to health care.
In such places, “you have fewer opportunities to take blood pressure measurements at home or in the office, and you can add less medication and titrate,” said Carey.
The main obstacle right now is that “there aren’t yet any major manufacturers making this low-dose quadruple combination, although we hope they will consider it now with this research evidence,” said Chow. “Combining early low doses of blood pressure medication is a far more effective way to achieve fast, safe, and effective blood pressure control with the lowest minimum total dose of medication.”
Although he found the results promising, Yang said he would like a longer clinical trial to treat people with higher blood pressure. He found that study participants started with an average blood pressure of 141/85 and the study aimed to help people get blood pressure below 140/90.
“They didn’t start at a point where they really had to do a lot to achieve that goal,” said Yang.
He also wants future studies to investigate whether the lower blood pressure brought about by the quad pill will help people avoid life-threatening diseases.
“What you really want to know is whether these interventions lead to significant benefits, such as reducing heart attacks, strokes, or heart failure,” said Yang.
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, Eastside Medicine Specialty Center, University of Washington, Bellevue; Robert Carey, MD, Dean Emeritus of the University of Virginia Medical School; The Lancet, August 29, 2021
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