Efficacy and Safety of Low-Dose Triple and Quadruple Combination Pills vs Monotherapy, Usual Care, or Placebo for the Initial Management of Hypertension: A Systematic Review and Meta-analysis
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 patients7 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
Methodological detailsrandom- and fixed-effects models
- Random- and fixed-effects models
Pooled result
As reported in the abstract
Mean reduction
7.4 mm Hg
95% CI 4.3–10.5
Low-dose combination (LDC) vs Monotherapy or usual care
Mean reduction
18.0 mm Hg
95% CI 15.1–20.8
LDC vs Placebo
Further pooled results
| Outcome | LDC | Monotherapy or usual care | Placebo | RR (95% CI) | |
|---|---|---|---|---|---|
| BP <140/90 mm Hg · 4 to 12 weeksLDCvs Monotherapy or usual care | 66% | 46% | — not stated in the abstract | 1.40 (1.27–1.52) | |
| BP <140/90 mm Hg · 4 to 12 weeksLDCvs Placebo | 54% | — not stated in the abstract | 18% | 3.03 (1.93–4.77) | |
| 0.20.5125Relative risk (log scale) |
— not stated in the abstract
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
- LDC remained superior to monotherapy or usual care
Safety
Dizziness
| RR (95% CI) | ||
|---|---|---|
| LDC14% 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: A Systematic Review and Meta-analysis. JAMA Cardiol. Published 1 June 2023. doi:10.
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