Sydney, Australia—If a single dose of one drug doesn’t effectively lower blood pressure or creates intolerable side effects, the solution might be to give less instead of more.
Specifically, a report in the journal Hypertension finds that quarter-dose combinations of blood pressure–lowering medications appear to work better.
“Widespread control of blood pressure is generally low, even in high-income countries. The largest global survey of hypertension patients showed 88% of those aware of hypertension are treated with medications, but only one in three were able to gain control of their blood pressure,” explained study coauthor Anthony Rodgers, MB, ChB, PhD, professor at The George Institute for Global Health at the University of New South Wales in Sydney, Australia. “Because high blood pressure is so common and serious, even small improvements in management can have a large impact on public health.”
The review is touted as the first to compare quarter-dose therapy to both standard dose and placebo.
For the meta-analysis, researchers used results of 42 trials involving 20,284 patients with high blood pressure on various doses of medications or taking no medication. Included in the review were ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and thiazides.
Results indicate that two medications in combination, each at a quarter dose, was just as effective as one blood pressure–lowering medication at a standard dose. The study also determined that four medications in combination, each at a quarter dose, was nearly twice as effective as taking one blood pressure–lowering medication at the standard dose.
At the same time, the side effects from single and dual quarter-dose therapies were about the same as from placebo and much less than from a standard dose of a single antihypertensive medication, according to study authors, although little information was available on side effects for the quadruple quarter-dose therapy.
The researchers caution, however, that not enough research exists yet to recommend a change in how physicians prescribe hypertension therapies. In addition, they said, few low-dose combinations are currently available.
“This new approach to treatment needs more research before it can be recommended more widely,” Rodgers emphasized. “The findings have not yet been tested in large long-term trials. People should not reduce the doses of their current medications.”
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