The George Institute for Global Health, UNSW Sydney (N.W., A.R., T.U., J.C., E.R.A., L.B.).
Faculty of Medicine and Health, Central Clinical School, University of Sydney, Australia (N.W.).
Hypertension. 2024 May;81(5):1087-1094. doi: 10.1161/HYPERTENSIONAHA.123.22284. Epub 2024 Mar 13.
Low-dose combinations are a promising intervention for improving blood pressure (BP) control but their effects on therapeutic inertia are uncertain.
Analysis of 591 patients randomized to an ultra-low-dose quadruple pill or initial monotherapy. The episode of therapeutic inertia was defined as a patient visit with a BP of >140/90 mm Hg without intensification of antihypertensive treatment. We compared the frequency of therapeutic inertia episodes between Quadpill and initial monotherapy as a proportion of the total population (intention-to-treat analysis with the denominator being all participants randomized) and as a proportion of people with uncontrolled BP (with the denominator being participants with uncontrolled BP).
Therapeutic inertia occurred in fewer participants randomized to Quadpill compared with monotherapy. For example, among the 390 participants with a 6-month follow-up, therapeutic inertia according to unattended BP was 21/192 (11%) versus 45/192 (23%), =0.002. There were similar rates of therapeutic inertia among those with uncontrolled unattended BP in each group (all >0.4). Consistent observations were seen with the use of attended office BP measures. The major determinants of not intensifying treatment during follow-up were BP readings that were close to target and large improvements in BP compared with the previous visit.
Among all treated individuals, low-dose Quadpill reduced the number of therapeutic inertia episodes compared with initial monotherapy. After the first follow-up visit, most high BP values did not lead to treatment intensification in both groups. Education is needed about the importance of treatment intensification despite a significant improvement in BP or BP being close to target.
URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12616001144404; Unique identifier: ACTRN12616001144404.
低剂量联合治疗是改善血压（BP）控制的一种很有前途的干预措施，但它们对治疗惰性的影响尚不确定。
对 591 名随机分配至超低剂量四联药或初始单药治疗的患者进行分析。治疗惰性的发作定义为血压>140/90mmHg 的患者就诊，而未加强降压治疗。我们比较了 Quadpill 和初始单药治疗之间的治疗惰性发作频率，以总人群（意向治疗分析，分母为所有随机分组的参与者）和未控制血压的人群（分母为未控制血压的参与者）中的比例表示。
与单药治疗相比，随机分配至 Quadpill 的患者中发生治疗惰性的比例较低。例如，在 390 名随访 6 个月的患者中，根据未监测血压，治疗惰性的发生率为 21/192（11%）与 45/192（23%），=0.002。每组中未控制的未监测血压患者的治疗惰性发生率相似（均>0.4）。使用有监测的诊室血压测量也观察到了类似的治疗惰性发生率。随访期间未加强治疗的主要决定因素是血压读数接近目标值和与前一次就诊相比血压有较大改善。
在所有治疗人群中，与初始单药治疗相比，低剂量 Quadpill 减少了治疗惰性发作的次数。在第一次随访后，两组中大多数高 BP 值并未导致治疗加强。需要教育患者，即使血压显著改善或接近目标值，也需要加强治疗。
