BACKGROUND:Low-dose combinations are a promising intervention for improving blood pressure (BP) control but their effects on therapeutic inertia are uncertain.METHODS:Analysis of 591 patients randomized to an ultra-low-dose quadruple pill or initial monotherapy. The episode of therapeutic inertia was defined as a patient visit with a BP of >140/90 mm Hg without intensification of antihypertensive treatment. We compared the frequency of therapeutic inertia episodes between Quadpill and initial monotherapy as a proportion of the total population (intention-to-treat analysis with the denominator being all participants randomized) and as a proportion of people with uncontrolled BP (with the denominator being participants with uncontrolled BP).RESULTS:Therapeutic inertia occurred in fewer participants randomized to Quadpill compared with monotherapy. For example, among the 390 participants with a 6-month follow-up, therapeutic inertia according to unattended BP was 21/192 (11%) versus 45/192 (23%), P=0.002. There were similar rates of therapeutic inertia among those with uncontrolled unattended BP in each group (all P>0.4). Consistent observations were seen with the use of attended office BP measures. The major determinants of not intensifying treatment during follow-up were BP readings that were close to target and large improvements in BP compared with the previous visit.CONCLUSIONS:Among all treated individuals, low-dose Quadpill reduced the number of therapeutic inertia episodes compared with initial monotherapy. After the first follow-up visit, most high BP values did not lead to treatment intensification in both groups. Education is needed about the importance of treatment intensification despite a significant improvement in BP or BP being close to target.REGISTRATION:URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12616001144404; Unique identifier: ACTRN12616001144404

中文翻译：

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初始低剂量四联疗法治疗高血压的治疗惰性：QUARTET 试验的结果


背景：低剂量组合是改善血压 (BP) 控制的一种有前景的干预措施，但其对治疗惰性的影响尚不确定。方法：对 591 名随机接受超低剂量四联药或初始单一疗法的患者进行分析。治疗惰性发作定义为患者就诊时血压>140/90 mm Hg，但未强化抗高血压治疗。我们比较了四联药和初始单一疗法之间治疗惰性发作的频率占总人口的比例（意向治疗分析，分母是所有随机参与者）和血压不受控制的人群的比例（分母是参与者）结果：与单一疗法相比，随机接受 Quadpill 的受试者较少出现治疗惰性。例如，在 390 名进行了 6 个月随访的参与者中，根据无人值守血压的治疗惰性分别为 21/192 (11%) 和 45/192 (23%)， P = 0.002。各组血压未受控制、无人值守的患者的治疗惰性率相似（均P >0.4）。使用值班办公室血压测量得出了一致的观察结果。随访期间不加强治疗的主要决定因素是血压读数接近目标值，并且与上次就诊相比血压有很大改善。结论：在所有接受治疗的个体中，与低剂量 Quadpill 相比，低剂量 Quadpill 减少了治疗惰性发作的次数。初始单一疗法。第一次随访后，两组的大多数高血压值都没有导致治疗强化。 尽管血压显着改善或血压接近目标，但仍需要对强化治疗的重要性进行教育。注册：URL：https://anzctr.org.au/Trial/Registration/TrialReview.aspx？ACTRN=ACTRN12616001144404；唯一标识符：ACTRN12616001144404