Sex differences in blood pressure lowering of initial treatment with ultra-low dose combination therapy versus monotherapy. A secondary analysis of QUARTET.

Women with hypertension are more likely than men to have ineffective treatment where blood pressure (BP) is treated but not controlled. The aim of this study was to investigate whether a quadpill based strategy differs between males and females. A secondary analysis of The Quadruple UltrA-low-dose tReaTment for hypErTension (QUARTET); randomized controlled trial. In this analysis the primary outcome was sex differences in unattended office systolic BP at 12 weeks. The QUARTET study recruited 591 participants (40% female) with mean age 59 (standard deviation 12) years [male 57 (12); female 62 (11)]. Males and females recorded a similar reduction in unattended systolic BP at 12 weeks with no interaction between group allocation and sex [male:mean difference (MD) in mmHg -6.95 (95% CI -9.53 to -4.38), female: MD -6.34 (95% CI -9.50 to -3.18), interaction P  = 0.77]. The quadpill strategy was similarly effective in men and women. Initiating BP control with a quadpill in women presents a promising approach to achieving similar BP control levels to men.