BP-Lowering Therapy May Improve Treatment Outcomes in Most Patients With Hypertension

Quarter-dose combinations of blood-pressure–lowering agents may improve treatment efficacy and tolerability in patients with hypertension, according to a recent systematic review and meta-analysis.

The researchers analyzed 20,284 participants and 42 randomized controlled trials with at least one quarter-dose and one placebo and standard-dose monotherapy arm.
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In their review and meta-analysis, the researchers used data on blood pressure and adverse events from the Medline, Embase, Cochrane Registry, US Food and Drug Administration, and European Medicinal Agency websites. A fixed-effect model was used to pool the data, and Cochrane risk of bias was used to determine bias.

The review included 42 trials, including 20,284 participants. A total of 36 comparisons assessed quarter-dose with placebo and indicated a blood pressure reduction of 4.7/2.4 mm Hg. Six comparisons evaluated dual quarter-dose therapy vs placebo and showed a reduction of 6.7/4.4 mm Hg. No trials were available to compare triple quarter-dose combination with placebo. One quadruple quarter-dose study demonstrated a blood pressure reduction of 22.4/13.1 mm Hg compared with placebo.

Analysis showed that single and dual quarter-dose therapy were not significantly different from placebo in terms of adverse events and had significantly fewer adverse events than standard-dose monotherapy. The researchers noted that quarter-dose combinations could improve efficacy and tolerability for patients undergoing blood-pressure–lowering therapy.

“This review suggests a potentially broader clinical role for low-dose blood pressure–lowering drugs,” the researchers concluded. “Use of dual quarter-dose blood pressure-lowering therapy may be preferable to standard-dose monotherapy, given comparable blood pressure reduction with better tolerability.”

—Christina Vogt

Reference:

Bennett A, Chow CK, Chou M, et al. Efficacy and safety of quarter-dose blood pressure–lowering agents: a systematic review and meta-analysis of randomized controlled trials [published online June 5, 2017]. Hypertension. https://doi.org/10.1161/HYPERTENSIONAHA.117.09202.