A first-line tablet combining four low-dose drugs, including a beta-blocker, may be the next step.
For clinicians, these developments signal a potential shift from the traditional stepwise escalation model toward earlier multidrug strategies and targeted pathway inhibition in resistant diseases.
Current guidelines recommend a stepwise strategy for the control of hypertension: initiate dual therapy for BP above 140/90 mm Hg, usually at low doses, and if BP targets are not achieved, escalate to triple therapy after 1-3 months. With this new triple therapy in a single tablet, “we are seeing a paradigm shift” that may influence future hypertension guidelines, according to Pathak.
The approval was based on the results of a phase 3 trial comparing a triple-combination pill with a placebo in untreated patients with hypertension. At 4 weeks, 70% of patients receiving low-dose triple therapy achieved BP below 140/90 mm Hg compared with 37% of those receiving placebo, with an average office systolic BP reduction of 9.4 mm Hg vs placebo.
A first-line combination of four antihypertensive agents at low doses, or “quadpill” may represent the next step in hypertension management. The QUARTET trial demonstrated the superiority of this treatment over standard monotherapy. In this study, a single capsule containing irbesartan, amlodipine, indapamide, and the beta-blocker bisoprolol was compared with standard-dose monotherapy with irbesartan (150 mg) alone.
RU
EN