Quarter Doses of Four Agents as Initial Therapy to Lower Blood Pressure

Most patients with hypertension are started on monotherapy, and many remain on monotherapy even when blood pressure (BP) control is inadequate, due to factors such as treatment inertia and concerns about adverse effects and costs. Studies of individual antihypertensive medications suggest that benefits outweigh side effects at low medication doses.

Australian researchers randomized almost 600 adults with hypertension (either untreated or receiving monotherapy) to daily “quadpills” that contained one quarter of the standard doses of four antihypertensive agents (i.e., 37.5-mg irbesartan, 1.25-mg amlodipine, 0.625-mg indapamide, and 2.5-mg bisoprolol) or to daily monotherapy with 150-mg irbesartan. Clinicians were free to escalate treatment, i…