Meta-analysis
Efficacy and Safety of Low-Dose Triple and Quadruple Combination Pills vs Monotherapy, Usual Care, or Placebo for the Initial Management of Hypertension
- Systematic review and meta-analysis of randomised trials
- random- and fixed-effects models
Authors' conclusion
The findings in the study showed that LDCs with 3 or 4 antihypertensives were an effective and well-tolerated BP-lowering treatment option for the initial or early management of hypertension.
Study context
- Population
- Patients with hypertension, initial management
- Participants
- 1,918 patients · 7 RCTs
- Comparison
- Low-dose triple or quadruple combination pills vs monotherapy, usual care or placebo
- Outcome
- Mean reduction in SBP
- Follow-up
- 4 to 12 weeks
Pooled result
As reported in the abstract
Mean reduction, mm Hg (95% CI)
LDC vs Monotherapy or usual care
7.4(4.3–10.5)
LDC vs Placebo
18.0(15.1–20.8)
Further pooled results
| Outcome | LDC | Monotherapy or usual care | Placebo | RR (95% CI) | |
|---|---|---|---|---|---|
| BP <140/90 mm Hg · 4 to 12 weeks — LDC vs Monotherapy or usual care | 66% | 46% | Not reported in the abstract | 1.40 (1.27–1.52) | |
| BP <140/90 mm Hg · 4 to 12 weeks — LDC vs Placebo | 54% | Not reported in the abstract | 18% | 3.03 (1.93–4.77) | |
| 0.20.5125Relative risk (log scale) |
Heterogeneity by baseline blood pressure (BP)-lowering therapy
- No significant heterogeneity between trials with and without baseline BP-lowering therapy
Systolic BP (SBP) reduction vs monotherapy or usual care (2 trials) · 6 to 12 months
- Low-dose combination (LDC) remained superior to monotherapy or usual care
Safety
Dizziness
| Comparison | RR (95% CI) | |
|---|---|---|
| LDC · 14% vs 11% | 1.28 (1.00–1.63) | |
| 0.512Relative risk (log scale) |
Other adverse effects and treatment withdrawal
- No increase in other adverse effects or treatment withdrawal
Original publication
Efficacy and Safety of Low-Dose Triple and Quadruple Combination Pills vs Monotherapy, Usual Care, or Placebo for the Initial Management of Hypertension. JAMA Cardiol. Published 1 June 2023. doi:10.1001/jamacardio.2023.0720
Summarised from the published abstract; every number is checked against it