Therapeutic Inertia With Initial Low-Dose Quadruple Combination Therapy for Hypertension : Results From the QUARTET Trial
BACKGROUND: Low-dose combinations are a promising intervention for improving blood pressure (BP) control but their effects on therapeutic inertia are uncertain.
METHODS: Analysis of 591 patients randomized to an ultra-low-dose quadruple pill or initial monotherapy. The episode of therapeutic inertia was defined as a patient visit with a BP of >140/90 mm Hg without intensification of antihypertensive treatment. We compared the frequency of therapeutic inertia episodes between Quadpill and initial monotherapy as a proportion of the total population (intention-to-treat analysis with the denominator being all participants randomized) and as a proportion of people with uncontrolled BP (with the denominator being participants with uncontrolled BP).
RESULTS: Therapeutic inertia occurred in fewer participants randomized to Quadpill compared with monotherapy. For example, among the 390 participants with a 6-month follow-up, therapeutic inertia according to unattended BP was 21/192 (11%) versus 45/192 (23%), P=0.002. There were similar rates of therapeutic inertia among those with uncontrolled unattended BP in each group (all P>0.4). Consistent observations were seen with the use of attended office BP measures. The major determinants of not intensifying treatment during follow-up were BP readings that were close to target and large improvements in BP compared with the previous visit.
CONCLUSIONS: Among all treated individuals, low-dose Quadpill reduced the number of therapeutic inertia episodes compared with initial monotherapy. After the first follow-up visit, most high BP values did not lead to treatment intensification in both groups. Education is needed about the importance of treatment intensification despite a significant improvement in BP or BP being close to target.
REGISTRATION: URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12616001144404; Unique identifier: ACTRN12616001144404.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:81 |
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| Enthalten in: |
Hypertension (Dallas, Tex. : 1979) - 81(2024), 5 vom: 17. Apr., Seite 1087-1094 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wang, Nelson [VerfasserIn] |
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| Links: |
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| Themen: |
Antihypertensive Agents |
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| Anmerkungen: |
Date Completed 19.04.2024 Date Revised 19.04.2024 published: Print-Electronic ClinicalTrials.gov: ACTRN12616001144404 Citation Status MEDLINE |
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| doi: |
10.1161/HYPERTENSIONAHA.123.22284 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a Date Revised 19.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: ACTRN12616001144404 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Low-dose combinations are a promising intervention for improving blood pressure (BP) control but their effects on therapeutic inertia are uncertain | ||
| 520 | |a METHODS: Analysis of 591 patients randomized to an ultra-low-dose quadruple pill or initial monotherapy. The episode of therapeutic inertia was defined as a patient visit with a BP of >140/90 mm Hg without intensification of antihypertensive treatment. We compared the frequency of therapeutic inertia episodes between Quadpill and initial monotherapy as a proportion of the total population (intention-to-treat analysis with the denominator being all participants randomized) and as a proportion of people with uncontrolled BP (with the denominator being participants with uncontrolled BP) | ||
| 520 | |a RESULTS: Therapeutic inertia occurred in fewer participants randomized to Quadpill compared with monotherapy. For example, among the 390 participants with a 6-month follow-up, therapeutic inertia according to unattended BP was 21/192 (11%) versus 45/192 (23%), P=0.002. There were similar rates of therapeutic inertia among those with uncontrolled unattended BP in each group (all P>0.4). Consistent observations were seen with the use of attended office BP measures. The major determinants of not intensifying treatment during follow-up were BP readings that were close to target and large improvements in BP compared with the previous visit | ||
| 520 | |a CONCLUSIONS: Among all treated individuals, low-dose Quadpill reduced the number of therapeutic inertia episodes compared with initial monotherapy. After the first follow-up visit, most high BP values did not lead to treatment intensification in both groups. Education is needed about the importance of treatment intensification despite a significant improvement in BP or BP being close to target | ||
| 520 | |a REGISTRATION: URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12616001144404; Unique identifier: ACTRN12616001144404 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a blood pressure | |
| 650 | 4 | |a cardiovascular diseases | |
| 650 | 4 | |a heart rate | |
| 650 | 4 | |a hypertension | |
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| 700 | 1 | |a Nelson, Mark R |e verfasserin |4 aut | |
| 700 | 1 | |a Nolde, Janis M |e verfasserin |4 aut | |
| 700 | 1 | |a Schlaich, Markus P |e verfasserin |4 aut | |
| 700 | 1 | |a Figtree, Gemma |e verfasserin |4 aut | |
| 700 | 1 | |a Hillis, Graham S |e verfasserin |4 aut | |
| 700 | 1 | |a Usherwood, Tim |e verfasserin |4 aut | |
| 700 | 1 | |a Reid, Christopher M |e verfasserin |4 aut | |
| 700 | 1 | |a Chalmers, John |e verfasserin |4 aut | |
| 700 | 1 | |a Jansen, Shirley |e verfasserin |4 aut | |
| 700 | 1 | |a Atkins, Emily R |e verfasserin |4 aut | |
| 700 | 1 | |a Billot, Laurent |e verfasserin |4 aut | |
| 700 | 1 | |a Chow, Clara |e verfasserin |4 aut | |
| 700 | 1 | |a Rodgers, Anthony |e verfasserin |4 aut | |
| 700 | 0 | |a QUARTET Investigators |e verfasserin |4 aut | |
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