The Art of the Quadpill: A New Strategy for Blood Pressure Control
The Art of the Quadpill: A New Strategy for Blood Pressure Control
Key Points:
• Hypertension management is shifting toward early multidrug therapy and single-pill strategies to improve BP control and adherence.
• Triple single-pill therapy (telmisartan + amlodipine + indapamide) showed 70% BP control vs 37% with placebo in a phase 3 trial.
(Note: Amlodipine may cause lower limb edema, dose-related; combining with ACE inhibitors or ARBs can reduce edema by ~38%, along with leg elevation or compression stockings.)
• Quadpill strategy (ultra-low quarter1/4-recommended dose combination of four antihypertensive drugs) showed greater BP reduction than standard monotherapy in the QUARTET trial.
• Quadpill strategy (ultra-low quarter-dose combination):
– Irbesartan 37.5 mg
– Amlodipine 1.25 mg
– Indapamide 0.625 mg
– Bisoprolol 2.5 mg
• Compared with standard monotherapy (Irbesartan 150 mg) in the QUARTET trial , the quadpill achieved greater BP reduction and better control rates.
• New therapies for resistant hypertension include:
– Baxdrostat (aldosterone synthase inhibitor)
– Aprocitentan (endothelin receptor antagonist).
• BaxHTN phase 3 trial (796 patients): SBP reduction ≈9–10 mmHg vs placebo.
• Additional cardiometabolic agents such as SGLT2 inhibitors and GLP-1 agonists also contribute to BP reduction.
Source
Medscape –
February 13, 2026