Low-dose combo antihypertensives effective for lowering BP

Low-dose combination (LDC) antihypertensives consisting of three or four blood pressure (BP)-lowering drugs are more effective for lowering BP compared with monotherapy, usual care, or placebo, according to a review published online April 26 in JAMA Cardiology.

Nelson Wang, M.D., from the University of New South Wales in Sydney, and colleagues examined the efficacy and safety of LDC therapies for the management of hypertension in a systematic review and meta-analysis of randomized clinical trials comparing LDC therapies to monotherapy, usual care, or placebo. Seven trials were reviewed, including 1,918 patients; of these trials, four evaluated triple-component LDC therapies and three evaluated quadruple-component LDC therapies.

The researchers found that LDC therapies were associated with a greater mean reduction in systolic BP than initial monotherapy or usual care (mean reduction, 7.4 mm Hg) and placebo (mean reduction, 18.0 mm Hg) at four to 12 weeks of follow-up. A higher proportion of participants achieved BP <140/90 mm Hg at four to 12 weeks with LDC therapies compared with both monotherapy or usual care (66 versus 46 percent, risk ratio, 1.40) and placebo (54 versus 18 percent; risk ratio, 3.03). Based on two trials, LDC therapies remained superior to monotherapy or usual care at six to 12 months. More dizziness was seen with LDC therapies, but no other adverse effects or treatment withdrawal were seen.

“LDC antihypertensives provide a single-step solution that has been shown to achieve 70 percent sustained BP control rates—an important therapeutic advance,” the authors write. “However, to achieve long-term control rates even higher than this, further research on the best strategy to tolerably intensify therapy for people taking LDCs is required.”

Several authors disclosed financial ties to the pharmaceutical industry; several authors have related patents pending.

More information:
Nelson Wang et al, Efficacy and Safety of Low-Dose Triple and Quadruple Combination Pills vs Monotherapy, Usual Care, or Placebo for the Initial Management of Hypertension, JAMA Cardiology (2023). DOI: 10.1001/jamacardio.2023.0720

Journal information:
JAMA Cardiology

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