A new strategy where patients are started on a pill containing four medicines, each at a quarter of their usual doses, has been shown to be much more effective in getting blood pressure under control, compared to the common practice of monotherapy, where treatment commences with just one drug, according to a study.

The multi-centre, Australian clinical trial of a potential future 'quadpill' dose of four medications, termed Quadruple UltrA-low-dose tReatment for hypErTension (QUARTET), has demonstrated that a single pill containing ultra-low quadruple combination is much more effective than the traditional approach of starting with monotherapy (single drug).

This novel combination of blood pressure medication brought blood pressure under control in 80 per cent of participants in 12 weeks, compared to 60 per cent in the control group who nonetheless had access to the best patient care. The results of the study were published in the journal The Lancet and are being presented at the world-leading European Society of Cardiology conference, ESC Congress 2021. "Statistics on the global burden of high blood pressure this week show that there's been a doubling in the past 30 years of hypertension cases -- the leading cause of the world's top killer: heart attack and stroke," said lead author Clara Chow, Professor and Director of the University of Sydney's Westmead Applied Research Center.

"The improved reduction in blood pressure with this strategy would be expected to reduce the risk of heart attacks and strokes by about 20 per cent. In settings with little or no existing hypertension treatment, the benefits would be much greater," added Emily Atkins from The George Institute for Global Health, University of New South Wales.

The study enrolled 591 participants with high BP either in no treatment or single therapy across 10 centres in Australia. The primary outcome was the significantly reduced BP, in the group starting on the quad pill, at 12 weeks. These differences were sustained, with blood pressure control still better with the quad pill approach compared to the standard approach at 12 months, and no differences in side effects.

Chow said a simple and effective combination quad pill strategy had the potential to impact people's lives worldwide. High BP is the world's leading killer cause of preventable deaths globally -- but poor rates of blood pressure control remain common.