# Kwartdosis antihypertensiva: systematische review en meta-analyse

*geplaatst 2017-07-01 · Hypertensie · Hypertension (Dallas, Tex. : 1979) · doi 10.1161/HYPERTENSIONAHA.117.09202 · https://hartvaat.nl/2017/07/01/kwartdosis-antihypertensiva-systematische-review-en-meta-analyse/*

Systematische review die de werkzaamheid en veiligheid van kwartdosis antihypertensiva onderzocht. Bouwt de evidence base voor lage-dosis combinatietherapie als startbehandeling.

## English: Efficacy and Safety of Quarter-Dose Blood Pressure-Lowering Agents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis of quarter-dose blood pressure-lowering agents showed that ultra-low-dose antihypertensive combinations provide meaningful blood pressure reduction with minimal side effects, building the evidence base for the low-dose combination approach.

## Abstract (original, from the publication)

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 (P<0.001). Six comparisons were of dual quarter-dose therapy versus placebo, observing a -6.7/ -4.4 mm Hg (P<0.001) blood pressure reduction. There were no trials of triple quarter-dose combination versus placebo, but one quadruple quarter-dose study observed a blood pressure reduction of -22.4/-13.1 mm Hg versus placebo (P<0.001). Compared with standard-dose monotherapy, the blood pressure differences achieved by single (37 comparisons), dual (7 comparisons), and quadruple (1 trial) quarter-dose combinations were +3.7/+2.6 (P<0.001), +1.3/-0.3 (NS), and -13.1/-7.9 (P<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.

Auteurs: Alexander Bennett, Clara K Chow, Michael Chou, Hakim-Moulay Dehbi, Ruth Webster, Abdul Salam, Anushka Patel, Bruce Neal, David Peiris, Jay Thakkar, John Chalmers, Mark Nelson, Christopher Reid, Graham S Hillis, Mark Woodward, Sarah Hilmer, Tim Usherwood, Simon Thom, Anthony Rodgers

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Bron: Hypertension (Dallas, Tex. : 1979), https://doi.org/10.1161/HYPERTENSIONAHA.117.09202. Bijgewerkt 2026-07-03T13:26:04Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.