Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia.
The George Institute for Global Health, University of New South Wales.
J Hypertens. 2024 Jun 1;42(6):1009-1018. doi: 10.1097/HJH.0000000000003683. Epub 2024 Feb 28.
A combination of four ultra-low-dose blood pressure (BP) medications lowered office BP more effectively than initial monotherapy in the QUARTET trial. The effects on average ambulatory BP changes at 12 weeks have not yet been reported in detail.
Adults with hypertension who were untreated or on monotherapy were eligible for participation. Overall, 591 participants were randomized to either the quadpill (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or monotherapy control (irbesartan 150 mg). The difference in 24-h, daytime, and night-time systolic and diastolic ambulatory BP at 12 weeks along further metrics were predefined secondary outcomes.
Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At 12 weeks, mean 24-h ambulatory SBP and DBP were 7.7 [95% confidence interval (95% CI) 9.6-5.8] and 5.3 (95% CI: 6.5-4.1) mmHg lower in the quadpill vs. monotherapy group ( P < 0.001 for both). Similar reductions in the quadpill group were observed for daytime (8.1/5.7 mmHg lower) and night-time (6.3/4.0 mmHg lower) BP at 12 weeks (all P < 0.001) compared to monotherapy. The rate of BP control (24-h average BP < 130/80 mmHg) at 12 weeks was higher in the quadpill group (77 vs. 50%; P < 0.001). The reduction in BP load was also more pronounced with the quadpill.
A quadruple quarter-dose combination compared with monotherapy resulted in greater ambulatory BP lowering across the entire 24-h period with higher ambulatory BP control rates and reduced BP variability at 12 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy.
QUARTET 试验表明，四种超低剂量降压药物联合治疗比初始单药治疗更能有效降低诊室血压。目前尚未详细报告其对 12 周时平均动态血压变化的影响。
未经治疗或接受单药治疗的高血压成人符合入组条件。共有 591 名参与者被随机分为四联组（厄贝沙坦 37.5mg、氨氯地平 1.25mg、吲达帕胺 0.625mg 和比索洛尔 2.5mg）或单药对照组（厄贝沙坦 150mg）。12 周时的 24 小时、日间和夜间收缩压和舒张压的动态血压差异以及其他指标为预设的次要结局。
在 576 名参与者中，289 名被随机分入四联组，287 名被分入单药组。12 周时，与单药组相比，四联组的 24 小时动态收缩压和舒张压分别低 7.7mmHg（95%置信区间 95%CI：9.6-5.8）和 5.3mmHg（95%CI：6.5-4.1）（均 P<0.001）。四联组在日间（8.1/5.7mmHg 更低）和夜间（6.3/4.0mmHg 更低）血压也有类似的降低（均 P<0.001）。12 周时，四联组的降压控制率（24 小时平均血压<130/80mmHg）也更高（77%比 50%；P<0.001）。四联组的血压负荷降低也更为显著。
与单药治疗相比，四重四分之一剂量联合治疗在整个 24 小时期间更能降低动态血压，降压控制率更高，12 周时血压变异性降低。这些发现进一步证实了基于超低剂量四联的降压策略的疗效。
