Division of Health System Innovation and Research, Department of Population Health Sciences Spencer Fox Eccles School of Medicine at the University of Utah Salt Lake City UT.
Feinberg School of Medicine Northwestern University Chicago IL.
J Am Heart Assoc. 2024 Jan 2;13(1):e032236. doi: 10.1161/JAHA.123.032236. Epub 2023 Dec 29.
This convergent parallel-design mixed-methods process evaluation of the QUARTET USA (Quadruple Ultra-Low-Dose Treatment for Hypertension USA) clinical trial (NCT03640312) explores patient and health care professional perceptions about the use of low-dose quadruple therapy (LDQT) as a novel strategy for hypertension management.
A survey of all 62 patients enrolled in the QUARTET USA trial was conducted. A subsample of 13 patients and 11 health care professionals, recruited via purposive sampling, took part in semistructured interviews. At enrollment, 68% of participants (mean [SD] age, 51.7 [11.5] years; 56% self-identified as Hispanic: Mexican ethnicity, 16% as Hispanic: other ethnicity, 16% as Black race, 8% as White race, and 1.6% as South Asian race) reported that their current health depended on blood pressure medications, and 48% were concerned about blood pressure medications. At trial completion, 80% were satisfied with LDQT, 96% were certain the benefits of taking LDQT outweighed the disadvantages, and 96% reported that LDQT was convenient to take. Both patients and health care professionals found LDQT acceptable because it reduced patients' perceived pill burden and facilitated medication adherence. Health care professionals stated that a perceived limitation of LDQT was the inability to titrate doses. Steps to facilitate LDQT implementation include introducing stepped-care combinations and treatment protocols, inclusion in clinical practice guidelines, and eliminating patient cost barriers.
LDQT was an acceptable strategy for hypertension treatment among patients and health care professionals involved in the QUARTET USA clinical trial. Although LDQT was generally perceived as beneficial for maintaining patients' blood pressure control and facilitating adherence, some clinicians perceived limitations in titration inflexibility, adverse effects, and costs.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03640312.
本项 QUARTET USA（美国四重超低剂量治疗高血压）临床试验（NCT03640312）的收敛平行设计混合方法过程评估探讨了患者和医疗保健专业人员对使用低剂量四联疗法（LDQT）作为高血压管理新策略的看法。
对 QUARTET USA 试验中纳入的所有 62 名患者进行了调查。通过目的性抽样，招募了 13 名患者和 11 名医疗保健专业人员作为亚组进行半结构访谈。入组时，68%的参与者（平均[标准差]年龄，51.7[11.5]岁；56%自认为是西班牙裔：墨西哥裔，16%是西班牙裔：其他族裔，16%是黑人，8%是白人，1.6%是南亚裔）报告称他们目前的健康状况取决于血压药物，48%担心血压药物。在试验完成时，80%的人对 LDQT 满意，96%的人确信服用 LDQT 的益处超过了缺点，96%的人报告 LDQT 服用方便。患者和医疗保健专业人员都认为 LDQT 是可以接受的，因为它降低了患者对药物的负担，并促进了药物的依从性。医疗保健专业人员表示，LDQT 的一个局限性是无法调整剂量。促进 LDQT 实施的步骤包括引入阶梯式治疗组合和治疗方案、纳入临床实践指南以及消除患者费用障碍。
LDQT 是参与 QUARTET USA 临床试验的患者和医疗保健专业人员治疗高血压的一种可接受的策略。虽然 LDQT 通常被认为有利于维持患者的血压控制和促进其依从性，但一些临床医生认为剂量调整缺乏灵活性、不良反应和成本存在局限性。
