Chow CK, Atkins ER, Hillis GS, et al. - Greater blood pressure lowering is achieved and maintained by using a strategy with early treatment of a fixed-dose quadruple quarter-dose combination vs the common strategy of starting monotherapy. A quadpill-based strategy is demonstrated to be an efficacious, tolerable, and simple strategy.

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

• Australian adults (≥ 18 years) with hypertension, who were untreated or receiving monotherapy, were randomly assigned to either treatment, that started with the quadpill (containing irbesartan at 37·5 mg, amlodipine at 1·25 mg, indapamide at 0·625 mg, and bisoprolol at 2·5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg).

• Additional blood pressure medications, starting with amlodipine at 5 mg, were required in 15% of the participants in the intervention group vs 40% participants in the control group.

• In the intervention group, lower systolic blood pressure by 6·9 mm Hg and greater blood pressure control rates (76%) were achieved relative to the control group (58%).

• Among patients who continued, more frequent uptitration occurred among control participants vs intervention participants.

• However, patients in the intervention group remained showed lower mean unattended systolic blood pressure by 7·7 mm Hg and higher blood pressure control rates compared with the control group.