Key result
The quadruple ultra-low-dose combination pill (quadpill) significantly reduced short-term systolic blood pressure by a mean difference of 13.00 mmHg compared to monotherapy or placebo.
Why the study?
Quadpill, a single pill containing a quadruple combination of quarter doses of four antihypertensive agents, has been investigated for hypertension, but its safety and efficacy required synthesized evaluation.
Does a quadruple ultra-low-dose combination pill (quadpill) reduce blood pressure more effectively than monotherapy or placebo in patients with hypertension?
Meta-Analysis (n=779)
Double-blind and single-blind
Randomized
Yes
Does a quadruple ultra-low-dose combination pill (quadpill) reduce blood pressure more effectively than monotherapy or placebo in patients with hypertension?
Mean Difference: -13 (95% CI -17.22–-8.78)
p-value: p=<0.00001
A quadruple ultra-low-dose combination pill (quadpill) provides superior blood pressure lowering and target achievement compared to monotherapy or placebo, without increasing adverse events.
Quadpill achieves superior short- and long-term SBP control; reinforces meta-analytic support for ultra-low-dose combinations in hypertension.
BACKGROUND AND OBJECTIVE: Quadpill, a single pill containing a quadruple combination of quarter doses of four antihypertensive agents, has been investigated for hypertension treatment. This meta-analysis aims to evaluate the safety and efficacy of quadpill for hypertension management. METHODS: We conducted a systematic review and meta-analysis synthesizing randomized controlled trials evaluating quadpill versus monotherapy or placebo in patients with hypertension, which were retrieved by systematically searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through 17 February, 2023. Continuous and dichotomous outcomes were pooled using mean difference (MD) and risk ratio (RR) along with confidence interval (CI), using Revman Version 5.4 software. Our protocol has been published in PROSPERO with ID: CRD42023406527. RESULTS: Four randomized controlled trials with a total of 779 patients were included in our analysis. Quadpill was effective in controlling systolic blood pressure in the short term [4-6 weeks] (RR: - 13.00 with 95% CI [- 17.22, - 8.78], p = 0.00001) and in the long term [12 weeks] (RR: - 6.18 with 95% CI [- 9.35, - 3.01], p = 0.0001). Quadpill was also effective in controlling automated diastolic blood pressure in the short term [4-6 weeks] (MD: - 8.15 with 95% CI [- 9.42, - 6.89], p = 0.00001) and in the long term [12 weeks] (MD: - 6.35 with 95% CI [- 10.37, - 2.33], p = 0.002). Moreover, patients in the quadpill group significantly achieved target blood pressure <140/90 (RR: 1.77 with 95% CI [1.26, 2.51], p = 0.001) compared with the control group. CONCLUSIONS: The quadruple ultra-low-dose combination of antihypertensive drugs (quadpill) was effective and safe for hypertension treatment. However, further large-scale, multicenter, randomized controlled trials are still warranted before endorsement in clinical practice.
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Abuelazm et al. (2023) conducted a meta-analysis in Hypertension (n=779). Quadpill (quadruple ultra-low-dose combination) vs. Monotherapy or placebo was evaluated on Automated systolic blood pressure in the short term (4-6 weeks) (MD -13.00, 95% CI -17.22, -8.78, p=<0.00001). The quadruple ultra-low-dose combination pill (quadpill) significantly reduced short-term systolic blood pressure by a mean difference of 13.00 mmHg compared to monotherapy or placebo.
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