A 4-in-1 Hypertension Treatment Has Been Made and This May Be Better Than What Was Traditionally Used


High blood pressure is a common condition people suffer from. This, unfortunately, increases the risk of developing further and more serious health problems. Those who suffer from it often use a single treatment, or monotherapy, to lower blood pressure. While the current form of treatment works, a new study suggests that using a combination of medications immediately may actually be a more effective treatment for high blood pressure. Researchers say that this could be the initial step rather than using a single medication.

Hypertension has become highly prevalent disease. So many suffer from it. In fact, in the United States alone, an estimated 45 percent of adults suffer from high blood pressure. The condition comes with a myriad of health risks associated. Hence, scientists are constantly searching and developing new treatment options to address this issue efficiently.

In fact, a new study has appeared in The Lancet. The researchers tried a novel medication regimen. What they did was they tested a single pill that contains ultra-low doses of four different blood pressure-lowering medications. The authors of the study observed that this four-in-one pill may be more effective than the single medication they’ve been using in lowering blood pressure.

The Relationship between Hypertension and Health

The National Heart, Lung, and Blood Institute defined blood pressure as the measurement of the pressure of blood flowing through the arteries of the body. This is measured using two readings: the systolic and diastolic pressures. The former is the blood pressure when the heart ventricles contract as it pumps blood out to the body. The latter, on the other hand, is blood pressure when the ventricles of the heart relax to fill up with blood once more.

A normal systolic blood pressure reading is less than 120 millimeters of mercury (mm Hg), and a normal diastolic reading is below 80 mm Hg. Doctors consider it hypertension when it involves a systolic reading of 130 mm Hg or more, and a diastolic reading of 80 mm Hg or higher.

In terms of treatment, doctors often encourage the patients to make lifestyle modifications as well as take some medication. Research is still being conducted and the experts are trying to develop the best medication options to treat high blood pressure. They are even looking into combining medications for it.


Combining Medications

When a person suffers from hypertension, a doctor typically prescribes one type of medication. If this medication isn’t effective, they oftentimes add another medication or switch to a different brand of single medication. The authors of the recent study made looked into starting people on a single pill that contained low doses of four different blood pressure-lowering medications. They say that this might be more effective than the traditional method.

Study author Prof. Clara K. Chow soke to Medical News Today and explained, “This randomized controlled trial questioned the paradigm of how we start in our management of people with hypertension. Instead of the common approach of starting with one drug at full dose and adding tablets, we started patients on a single pill containing four medicines each at a quarter of standard dose.”

The trial performed was randomized, double-blind, active-controlled. This means that the participants assigned to the control and experimental groups was randomly selected. Neither the participants nor the researchers knew which group fell into what when they started to collect the data. More importantly, rather than the control group not receiving any treatment, they received standard care that many of us are familiar with.

At the start of the trial, the participants involved either had untreated high blood pressure or were only prescribed one type of medication. Furthermore, the study included a total of 591 participants. The first 300 participants were in the intervention group and the next 291 participants were placed in the control group. Those in the intervention group received what the referred to as the “quadpill.” This treatment contained low doses of four medications that doctors had been prescribing for high blood pressure: irbesartan, amlodipine, indapamide, and bisoprolol.

The control group, on the other hand, got irbesartan starting at 150 milligrams. If blood pressure remained high for participants both groups, the experts had the choice to add other medications to their treatment regimen, and the started with amlodipine. 

The in the successive portion of the research, the experts then evaluated the groups over a 12-week period. Moreover, they followed a small number from each group assigned over the next 12 months to examine its longer term effects.

The results of the study showed more significant blood pressure improvements in the intervention group when compared to the control group. The authors also elaborated the following differences between the two groups in a report made:

  1. In the intervention group, 15 percent of participants required additional medication to control blood pressure when compared to the 40 percent of the participants in the control group.
  2. Generally, the systolic blood pressure readings were lower in the intervention group than the control group.
  3. The rates of blood pressure control were higher, at 76 percent, in the intervention group than in the control group, which was at 58 percent.
  4. During the 12-month observation period, there was more of a need to increase medication in the control group more than in the intervention group.
  5. Average systolic blood pressure readings remained lower overall for the intervention group. This was compared to the observations made in control group for the same time period.

The researchers also observed that the adverse effects that were related to the quadpill treatment were comparable to the standard care. They noted that “[t]here was no excess in serious adverse events or acute kidney injury associated with the quadpill, but there were no types of adverse effects that occurred less frequently in the quadpill group compared with standard care.”


Study Limitations Seen and Plans Made Moving Forward

The study revealed just how effective the combined medication in when treating high blood pressure. Prof. Chow spoke to MNTand said, “The ‘quadpill’ approach was superior to the common approach. The BP [blood pressure] differences were sustained even at 12 months, that is we didn’t see ‘catch-up’ between the arms of the trial. It demonstrates that early low dose combination is a quick, more effective, and much simpler way of getting patients to BP control safely.”

However, the study recently made came with limitations. The researchers were not able to gather their ideal sample size because of the COVID-19 pandemic restrictions. This fact limited the overall strength of the results made. Moreover, the study was conducted in relatively short time frame, which means that the researchers were not able to fully measure long-term cardiovascular outcomes.

MNT also interviewed Prof. Bernard M. Y. Cheung from the Department of Medicine at the University of Hong Kong about this. He talked about the limitations of the study and he reiterated that the study included a relatively small number of participants. He pointed out the demographics and said, “Eighty-two percent of the study participants were white. The results should, therefore, be interpreted with a degree of caution for other ethnic groups. For instance, in Chinese people, a calcium channel blocker alone achieves good blood pressure lowering, and in Black people, a diuretic may be better than irbesartan or other drugs in its class.”

The authors also pointed out the fact that the doctors outside the study would probably be more resistant or somewhat slower in increasing the dosages of medicines than the doctors involved in the study. This shows that the results may actually underestimate the benefits involved. This is why the experts continue to encourage further evaluation of the efficacy and tolerability of the quadpill treatment when compared with other usual treatment regimens.

Nonetheless, this medication combination may offer another treatment option when it comes to hypertension. Dr. Paz was asked to comment on the study. He is the cardiologist and vice president of medical at K Health. He gave a positive response to the study. He spoke about further research and said, “This study aligns with a few concepts we know to be true regarding blood pressure management. For one, multiple medications at lower doses likely have higher effectiveness and lower side effects than higher doses of a single medication. In addition, people with blood pressure significantly above goal will often require multiple medications.”

However, Dr. Paz also added a note of caution. He explained, “Using so many different medications may actually increase [the] risk of side effects, and there was such a signal in this study. Overall, the study is small, so it is not likely to change practice significantly. But this overall strategy does merit further study, as a single pill may increase patient compliance with medications.”