{
  "abstract": "Background Hypertension is a major cause of premature death worldwide, controlled by only one in five adults. Two trials (Australia and USA) found a single quadpill containing a quarter dosage of four classes of medication effective in reducing blood pressure (BP) among participants with hypertension. By pooling these trials, we can estimate the overall benefit of the quadpill and its heterogeneity across subgroups and two important barriers for BP control: clinician medication inertia and participant medication adherence.Methods In a prespecified pooled individual participant data analysis of two QUARTET randomised, multicentre, double-blinded trials in people with hypertension using ≤1medication, quadpill (irbesartan (37.5 mg) (Australia)/candesartan (2 mg) (USA)), amlodipine (1.25 mg), indapamide (0.625 mg), bisoprolol (2.5 mg) unattended office systolic BP (SBP) at 12 weeks was compared with initial monotherapy (irbesartan (150 mg) (Australia), candesartan (8 mg) (USA)). Heterogeneity was assessed using an interaction term in the mixed cox model. Adherence, ≥80% pill count and treatment inertia were estimated.Results In 653 participants (Australia, 591 (91%); USA, 62 (9%)) a significant drop in mean SBP (6.5 mm Hg (95% CI 4.8 to 8.8; p<0·001)) and diastolic BP (5.6 mm Hg (95% CI 4.5 to 6.9; p<0.001)) in favour of the quadpill was found, with less need for uptitration (p<0.001) and less treatment inertia (non-significant: p=0.303). Adherence was high for both treatment arms (over 80%). Compared with monotherapy, the quadpill effect varied by ethnicity (SBP reduced by White (6.9 mm Hg; 95% CI 4.7 to 9.2), Hispanic (3.3 mm Hg; 95% CI 4.0 to 10.6), Asian (12.3 mm Hg; 95% CI 6.2 to 18.5) and Black/other (1.4 mm Hg; 95% CI −9.0 to 6.3), interaction p=0.032).Conclusion This prospective individual participant data pooled analysis provides further evidence that the quadpill strategy is superior to initial monotherapy by virtue of improved BP-lowering, less need for uptitration and being associated with less treatment inertia.",
  "authors": [
    {
      "affiliations": [
        "Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia"
      ],
      "name": "Simone Marschner"
    },
    {
      "affiliations": [
        "Cardiovascular Division and Global Health Center, Washington University in St Louis, St. Louis, Missouri, USA",
        "Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA"
      ],
      "name": "Mark D Huffman"
    },
    {
      "affiliations": [
        "The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Desi quintans"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA",
        "Northwestern University Data Analysis and Coordinating Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Jody Ciolino"
    },
    {
      "affiliations": [
        "Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Abigail Baldridge"
    },
    {
      "affiliations": [
        "Access Community Health Network, Chicago, Illinois, USA"
      ],
      "name": "Danielle Lazar"
    },
    {
      "affiliations": [
        "Health Systems Science, The George Institute for Global Health, Newtown, New South Wales, Australia",
        "UNSW, Sydney, New South Wales, Australia"
      ],
      "name": "Emily R Atkins"
    },
    {
      "affiliations": [
        "Royal Perth Hospital and Medical School, The University of Western Australia, Perth, Australia"
      ],
      "name": "Graham S Hillis"
    },
    {
      "affiliations": [
        "Discipline of General Practice, University of Tasmania Menzies Institute for Medical Research, Hobart, Tasmania, Australia"
      ],
      "name": "Mark R Nelson"
    },
    {
      "affiliations": [
        "Dobney Hypertension Centre, The University of Western Australia, Perth, Australia",
        "Royal Perth Hospital, Royal Perth Hospital, Perth, Western Australia, Australia"
      ],
      "name": "Markus Schlaich"
    },
    {
      "affiliations": [
        "Cardiovascular, The George Institute for Global Health, Sydney, New South Wales, Australia"
      ],
      "name": "Anthony Rodgers"
    },
    {
      "affiliations": [
        "Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Clara K Chow"
    }
  ],
  "title": "Pooled randomised QUARTET trials assessing effectiveness of a single pill for hypertension",
  "uid": "6ef024de-47e1-5e8e-8afd-4467a60c2348"
}