# QUARTET: therapeutische inertie bij lage-dosis viervoudige combinatietherapie

*geplaatst 2024-05-01 · Hypertensie · Hypertension (Dallas, Tex. : 1979) · doi 10.1161/HYPERTENSIONAHA.123.22284 · https://hartvaat.nl/2024/05/01/quartet-therapeutische-inertie-bij-lage-dosis-viervoudige-combinatietherapie/*

Analyse van QUARTET onderzocht therapeutische inertie bij initiële lage-dosis quadpil voor hypertensie. De quadpil verminderde de therapeutische inertie doordat de lage dosis sneller geaccepteerd werd dan standaard monotherapie.

## English: Therapeutic Inertia With Initial Low-Dose Quadruple Combination Therapy for Hypertension: Results From the QUARTET Trial.

This QUARTET analysis showed that initial low-dose quadruple combination therapy for hypertension reduces therapeutic inertia compared with standard care, as clinicians are less reluctant to continue simplified combination treatment.

## Abstract (original, from the publication)

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.

Auteurs: Nelson Wang, Amy Von Huben, Simone Marschner, Mark R Nelson, Janis M Nolde, Markus P Schlaich, Gemma Figtree, Graham S Hillis, Tim Usherwood, Christopher M Reid, John Chalmers, Shirley Jansen, Emily R Atkins, Laurent Billot, Clara Chow, Anthony Rodgers

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Bron: Hypertension (Dallas, Tex. : 1979), https://doi.org/10.1161/HYPERTENSIONAHA.123.22284. Bijgewerkt 2026-07-03T13:29:57Z. 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.