Key result
A low-dose quadruple antihypertensive combination reduced mean arterial pressure by 19 mm Hg, significantly more than standard single doses of the individual agents (P<0.01).
Why the study?
Does a low-dose quadruple antihypertensive combination reduce mean arterial pressure more than standard single doses of individual agents in untreated hypertensive patients?
RCT (n=108)
parallel group
Does a low-dose quadruple antihypertensive combination reduce mean arterial pressure more than standard single doses of individual agents in untreated hypertensive patients?
A low-dose quadruple combination pill of antihypertensive agents provides significantly greater blood pressure reduction than standard monotherapy in untreated hypertensive patients.
Answers are grounded in this paper and cite their sources.
Supports initial low-dose quadruple therapy in untreated hypertension; confirms greater efficacy than standard monotherapy in this RCT.
Increasingly combined antihypertensive agents are being used in practice to enhance control and improve compliance. To determine whether a capsule containing a quarter of the standard dose of 4 antihypertensive agents has greater efficacy than the standard dose of each individually, we prospectively randomized 108 untreated white hypertensive patients (55% male) aged 50+/-1 years (mean+/-SEM), with mean blood pressure 160+/-1/96+/-1 mm Hg. Patients received amlodipine (5 mg; n=22), atenolol (50 mg; n=20), bendroflumethiazide (2.5 mg; n=22), captopril (50 mg twice daily; n=22) or a capsule containing each of the 4 above at one-quarter dosage (n=22) in a parallel group design for 4 weeks. Blood pressure was measured using a semiautomated device (Omron 705), and the reduction in mean arterial pressure with the combined preparation was compared with that of the individual components. Statistical analysis used ANOVA and Tukey-Kramer honestly significant difference for multiple comparisons. The reduction in mean arterial pressure with the combination (19+/-2 mm Hg) was significantly greater than that with individual agents amlodipine (10+/-2 mm Hg; P<0.005), atenolol (10+/-2 mm Hg; P<0.005), bendroflumethiazide (6+/-1 mm Hg; P<0.005), and captopril (11+/-1 mm Hg; P<0.01). In addition, the percentage reduction in systolic (18+/-1 mm Hg; P<0.005) and diastolic (17+/-2 mm Hg; P=0.06) blood pressure was greater with the combination. More patients achieved a blood pressure of <140/90 mm Hg with the combination (60%) than any individual drug (15% to 45%; P<0.05). A low-dose combination of 4 agents representing 4 classes of standard antihypertensive agents was more efficacious than a standard single dose of each agent individually.
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Mahmud et al. (2006) conducted an RCT in Hypertension (n=108). Low-dose quadruple antihypertensive combination vs. Standard single dose of amlodipine, atenolol, bendroflumethiazide, or captopril was evaluated on Reduction in mean arterial pressure (p=<0.01). A low-dose quadruple antihypertensive combination reduced mean arterial pressure by 19 mm Hg, significantly more than standard single doses of the individual agents (P<0.01).
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