Chow CK, Atkins ER, Hillis GS, et al. - Greater blood pressure lowering was achieved and maintained when using a strategy with early treatment of a fixed-dose quadruple quarter-dose combination (containing irbesartan at 37·5 mg, amlodipine at 1·25 mg, indapamide at 0·625 mg, and bisoprolol at 2·5 mg) compared with the common strategy of starting monotherapy. In this trial, a quadpill-based strategy was supported as efficacious, tolerable, and simple.

• QUARTET was a multicenter, double-blind, parallel-group, randomized, phase 3 trial.

• Australian adults (≥18 years) with hypertension were randomly assigned to receive treatment with a single pill containing ultra-low-dose quadruple combination therapy or an indistinguishable monotherapy control (irbesartan 150 mg).

• Initiating with amlodipine at 5 mg, additional medications could be administered in both groups, if blood pressure was not at target.

• By 12 weeks, additional blood pressure medications were required in 15% of participants in the intervention group vs 40% of participants in the control group.

• Participants in the intervention group had lower systolic blood pressure by 6·9 mm Hg and higher blood pressure control rates (76%) when compared with participants in the control group (58%).

• Adverse event-related treatment withdrawals at 12 weeks did not differ.

• More frequent uptitration occurred among control participants.

• At 52 weeks, lower mean unattended systolic blood pressure by 7·7 mm Hg and higher blood pressure control rates (81%) remained among participants in the intervention group relative to those in control group (62%).