Quadruple UltrA-low-dose tReaTment for hypErTension – QUARTET

Hypertension affects about six million people in Australia. It is a major risk factor for heart attack and stroke, which are the leading causes of death in Australia. However, effective management of hypertension can prevent such events. While hypertension can be managed, surveys have shown approximately 50 to 75% of patients are unable to maintain their blood pressure below the recommended target of less than 130-140/80-90 mmHg. Evidence suggests that low dose blood pressure lowering combination therapy could achieve better and quicker BP control with less side effects than current guideline recommended approaches. Combining different medicines into a single pill simplifies treatment and is likely to improve long-term adherence. The rate of side effects with ¼ dose agents is very low, but more data are needed on combination therapy.

This randomised controlled study aims to recruit 650 participants to investigate whether a single pill containing 4 types of blood pressure lowering medications at quarter- standard doses will more effectively lower blood pressure and have fewer side effects compared to a standard dose of a single type of hypertensive medication.

Inclusion criteria for the study are previous documentation of hypertension or high blood pressure (SBP 140-179mmHg and/or DBP 90-109 mmHg) from GP, pharmacist or health care professional and either clinic SBP 140-179mmHg and/or DBP 90-109 mmHg documented by study staff within the last 12 weeks with a study automatic BP device OR a recorded measure of daytime average SBP ≥ 135 mmHg and/or DBP ≥ 85 mmHg on a 24 hour ambulatory BP monitoring device in the last 12 weeks. The subject must also be neither not currently treated for hypertension or currently taking one type of BP lowering drug.

The study is being conducted By Monash University and the George Institute for Global Health, NSW and is funded by the NHMRC