Australia
Australia
The Socceroos made a grand entrance into the 2022 World Cup (Video 1). Timely plays and a balanced attack sealed the qualifying victory. Those tactics are on display with their NephroWorldCup entry as well. Aussies know the difficulties of treating hypertension. Despite its increasing ubiquity in the population and the variety of medications available for treatment, hypertension treatment continues to perplex physicians and patients. Most physicians initiate treatment with monotherapy: a strategy that seems to be less effective than an initial multi-drug approach (Figure 1).
Figure 1: Multi-drug anti-hypertensive medication approach and BP effect | Presented at the 2019 University of Utah Hypertension Meeting | Courtesy of Dr. Natalie Bello (zoom in for details)
Video 1: The Socceroos qualify for the 2022 World Cup
Earlier studies (STICH and TRIUMPH) suggested that a multi-drug approach in which the individual dosing of each component is a fraction of the full-dose used in monotherapeutic regimens would have a greater BP lowering effect than the standard practice of sequentially up-titrating a medication before adding on a new agent. The Socceroos turn that practice on its head by entering the QUARTET study in this year's Tournament (Figure 2).
Figure 2: Objectives of the Quartet trial | Presented at the 2021 European Society of Cardiology meeting |Courtesy of Dr. Anastasia Milhailidou (zoom in for details)
In QUARTET, nearly 600 hypertensive patients were randomized to receive monotherapy with irbesartan 150 mg daily or a 'quadpill' in which a quarter (1/4) dose of four (4) medications were combined into one (1) pill (Figure 3). The primary outcome was the change in systolic blood pressure at twelve (12) weeks with a key secondary outcome of a change in systolic BP at twelve (12) months (52 weeks) (Figure 2).
Figure 3: Quadpill composition | Presented at the 2021 European Society of Cardiology meeting |Courtesy of Dr. Anastasia Milhailidou (zoom in for details)
Figure 3: Results of the primary outcome | Presented at the 2021 European Society of Cardiology meeting |Courtesy of Dr. Rosa Bruno (zoom in for details)
The 'quadpill' showed a significant reduction in SBP at both primary and secondary outcome time points (Figures 3 and 4). The primary outcome measure of BP was 120 mm Hg (SD 14)/71 mm Hg (SD 10) in the 'quadpill' group versus 127 mm Hg (SD 13)/79 mm Hg (SD 10) in the irbesartan monotherapy group (Figure 3). The mean systolic blood pressure difference between groups was –6·9 mm Hg (95% CI –4·9 to –8·9; p<0·001). Those BP gains were sustained in the twelve- (12) month double-blind extension period (Figure 4).
Figure 4: Results of the quadpill | Presented at the 2021 European Society of Cardiology meeting | Courtesy of Drs. Pascal Meier and Rosa Bruno (zoom in for details)
The Socceroos bring a balanced attack to The NephroWorldCup. Patients achieve blood pressure control faster using the 'quadpill' than those who undergo the traditional sequential dose escalation strategy. Those results are sustained over a 52-week period, which makes the 'quadpill' strategy an extremely attractive one for the initial treatment of hypertension.