Managing hypertension: changing tack

Quarter-dose combinations of antihypertensives appear to be as effective as a single dose of one drug and result in fewer side effects.

This is the main finding from a global survey of hypertension patients conducted by the University of NSW’s George Institute for Global Health.

The researchers analysed and compared results from 42 trials, involving 20,284 people with high blood pressure on various doses of medications or placebo.

The review included ACEIs, angiotensin receptor blockers, beta blockers, calcium channel blockers and thiazides.

The researchers found:

  • A combination of two medications, each at a quarter dose, was just as effective as one antihypertensive at standard dose.
  • A combination of four medications, each at a quarter dose, was nearly twice as effective as taking one at the standard dose.
  • The side effects from single and dual quarter-dose therapies were about the same as from placebo, and much less than from a standard dose of a single antihypertensive medication. There was little information on the side effects for the quadruple quarter-dose therapy.

While all this looks promising, the researchers caution there is not enough evidence yet to warrant a change in clinical practice recommendations.

Also, they note there are few low-dose combinations currently available.

Nonetheless, this review suggests a potentially broader clinical role for low-dose blood pressure-lowering drugs, they say.

“Use of dual quarter dose blood pressure-lowering therapy may be preferable to standard-dose monotherapy, given comparable blood pressure reduction with better tolerability,” write Dr Anthony Rodgers and colleagues in the journal Hypertension.