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Efficacy and safety of quarter-dose blood pressure-lowering agents: a systematic review and meta-analysis of randomized controlled trials

Bennett, A, Chow, CK, Chou, M, Dehbi, HM, Webster, R, Salam, A, Patel, A, Neal, B, Peiris, D, Thakkar, J, Chalmers, J, Nelson, M ORCID: 0000-0001-9941-7161, Reid, C, Hillis, GS, Woodward, M, Hilmer, S, Usherwood, T, Thom, S and Rodgers, A 2017 , 'Efficacy and safety of quarter-dose blood pressure-lowering agents: a systematic review and meta-analysis of randomized controlled trials' , Hypertension, vol. 70, no. 1 , pp. 85-93 , doi: 10.1161/HYPERTENSIONAHA.117.09202.

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Abstract

There is a critical need for blood pressure-lowering strategies that have greater efficacy and minimal side effects. Low-dose combinations hold promise in this regard, but there are few data on very-low-dose therapy. We, therefore, conducted a systematic review and meta-analysis of randomized controlled trials with at least one quarter-dose and one placebo and standard-dose monotherapy arm. A search was conducted of Medline, Embase, Cochrane Registry, Food and Drug Administration, and European Medicinal Agency websites. Data on blood pressure and adverse events were pooled using a fixed-effect model, and bias was assessed using Cochrane risk of bias. The review included 42 trials involving 20 284 participants. Thirty-six comparisons evaluated quarter-dose with placebo and indicated a blood pressure reduction of -4.7/-2.4 mm Hg (PPPPP<0.001) mm Hg, respectively. In terms of adverse events, single and dual quarter-dose therapy was not significantly different from placebo and had significantly fewer adverse events compared with standard-dose monotherapy. Quarter-dose combinations could provide improvements in efficacy and tolerability of blood pressure-lowering therapy.

Item Type: Article
Authors/Creators:Bennett, A and Chow, CK and Chou, M and Dehbi, HM and Webster, R and Salam, A and Patel, A and Neal, B and Peiris, D and Thakkar, J and Chalmers, J and Nelson, M and Reid, C and Hillis, GS and Woodward, M and Hilmer, S and Usherwood, T and Thom, S and Rodgers, A
Keywords: blood pressure, hypertension, meta-analysis, pharmacology, safety
Journal or Publication Title: Hypertension
Publisher: Lippincott Williams & Wilkins
ISSN: 0194-911X
DOI / ID Number: 10.1161/HYPERTENSIONAHA.117.09202
Copyright Information:

© 2017 American Heart Association

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