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REFLECTIONS
Hypertension
Hypertension Global Newsletter #7 2024

standard treatment group, p=0.010) and primary outcome or death from any cause (11.3% in the intensive treatment group vs. 12.7%
in the standard treatment group, p=0.039). Other secondary outcomes were numerically, but not significantly better, for the intensive
treatment group. The study also showed no heterogeneity of effects by diabetes status, duration of diabetes, or history of stroke.
Hypertension
Primary and secondary outcomes

Serious adverse events of syncope occurred more frequently less than 10 mL/min per 1.73 m² occurred in three participants,
in the intensive treatment group (0.4%) than in the standard all from the intensive treatment group.
treatment group (0.1%; HR 3.00, 95% CI 1.35–6.68), but there
was no significant between-group difference in the serious For hypertensive patients at high cardiovascular risk, regardless
adverse events of hypotension, electrolyte abnormality, of the status of diabetes or history of stroke, the treatment
injurious fall, or acute kidney injury. The composite kidney strategy of targeting systolic blood pressure of less than 120
outcome (i.e., end-stage renal disease, a sustained decline in mmHg, as compared with that of less than 140 mmHg, prevents
eGFR to <10 mL/min per 1.73 m², death from renal causes, or major vascular events, with minor excess risk.
a sustained decline ≥40% in eGFR from baseline) occurred in
169 (3.0%) participants from the intensive treatment group and
in 102 (1.8%) from the standard treatment group (HR 1.70; CLICK HERE
95% CI 1.33–2.17). End-stage renal disease occurred only in FOR THE LINK TO FULL ARTICLE
one participant and a sustained decline in eGFR to a value of

Therapeutic inertia with initial low-dose quadruple combination therapy for
hypertension: Results from the QUARTET trial.

Wang N, et al. Hypertension. 2024 May;81(5):1087-1094.

Hypertension is the leading modifiable risk factor for cardiovascular disease, but current BP control rates are poor worldwide, with
less than 50% of treated patients achieving BP <140/90. Therapeutic inertia, defined as not intensifying treatment in patients with
uncontrolled BP, is common in hypertension management. The QUARTET (Quadruple Ultra-Low-Dose Treatment for Hypertension)
was a randomised controlled trial comparing initial ultra low-dose quadruple pill versus initial monotherapy on the incidence of
therapeutic inertia in patients with hypertension.

Therapeutic inertia (TI) was defined here as a patient visit with a BP >140/90 mmHg without intensification of antihypertensive treatment.
A total of 591 patients were randomised to a once-daily Quadpill, a single pill containing quarter-standard doses of four BP medications
(irbesartan at 37.5 mg, amlodipine at 1.25 mg, indapamide at 0.625 mg, and bisoprolol at 2.5 mg) or irbesartan 150 mg (standard dose
monotherapy). Treatment intensification was recommended according to local guidelines, although it was suggested in the protocol to

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