4 in 1 blood Pressure Pill Much More Effective than Monotherapy

The first large-scale, long-term trial of a new strategy using combinations of very low doses in one capsule, has demonstrated significantly improved control of high blood pressure – the leading cause of heart attack and stroke.

High blood pressure is the world’s leading killer but poor rates of blood pressure control remain common. A new strategy where patients are started on a pill containing four medicines, each at a quarter of their usual doses, has been shown to be much more effective in getting blood pressure under control, compared to the common practice of monotherapy, where treatment commences with just one drug.

This first large-scale, randomised controlled clinical trial of starting this novel combination blood pressure medication brought blood pressure under control in 80 percent of participants in 12 weeks, compared to 60 percent in the control group who nonetheless had access to the best patient care.

Traditionally doctors have started with one drug and then follow up to consider adding or changing treatment – but this strategy is often not successful in practice and blood pressure control rates have remained stubbornly low for decades.

The results of the Australian study published today in The Lancet and are being presented at the world-leading European Society of Cardiology conference, ESC Congress 2021.

Professor Clara Chow, lead and corresponding author and Director of the University of Sydney’s Westmead Applied Research Centre, said in a separate Comment in The Lancet this week that control of high blood pressure, known as hypertension, was not ideal anywhere, and in some regions such as Africa fewer than one in 10 had hypertension under control.

“Statistics on the global burden of high blood pressure this week show that there’s been a doubling in the past 30 years of hypertension cases – the leading cause of the world’s top killer: heart attack and stroke,” Professor Chow said.

Dr Emily Atkins from The George Institute for Global Health, UNSW Sydney and the University of Sydney said: “In settings with high levels of specialist care and full access to a range of existing blood pressure medicines – like the centres in this trial – the improved reduction in blood pressure with this strategy would be expected to reduce the risk of heart attacks and strokes by about 20 percent. In settings with little or no existing hypertension treatment, the benefits would be much greater.”

About the trial

The multi-centre, Australian clinical trial of a potential future ‘quadpill’ dose of four medications, termed Quadruple UltrA-low-dose tReatment for hypErTension (QUARTET), has demonstrated that a single pill containing ultra-low quadruple combination is much more effective than the traditional approach of starting with monotherapy (single drug).

The study funded by the National Health and Medical Research Council enrolled 591 participants with high blood pressure either in no treatment or single therapy across 10 centres in Australia. The primary outcome was the significantly reduced blood pressure in the group starting on the quadpill, at 12 weeks. These differences were sustained, with blood pressure control still better with the quadpill approach compared to the standard approach at 12 months, and no differences in side effects.

Senior author Professor Anthony Rodgers of The George Institute, UNSW Sydney and Imperial College London, said: “Our trial has overwhelmingly demonstrated the efficacy, tolerability and safety of this ultra-low-dose combination strategy – a potentially simple and scalable hypertension management strategy to treat hypertension.”

Professor Chow said the study built on their previous study comparing a quadpill approach to placebo. “We aimed to test this new quadpill strategy against usual care in Australia; as is often seen in clinical trials, people in the comparison group got much better treatment than average. Nonetheless our new quadpill strategy was much better,” she said.

“This was the first study to show the benefits are maintained long-term without any reduction over time. Even though much more add-on blood pressure medicines were used in the comparison group throughout follow-up, they never caught up with the quadpill group.”

Changing global practice

Professor Chow said there were still important research questions. “For people who may be having side effects from their current treatments, we would like to know whether a switch to an utra-low-dose combination can improve things.”

“Also, the WHO Hypertension Guidelines released this week, just like other recent hypertension guidelines in Europe, US and elsewhere, recommend most patients start on two blood pressure drugs rather than one. We need to know how that would compare to a quadpill strategy.”

There is also a major research translation challenge ahead: “These kinds of strategies will only make a major impact on global health if they are available and affordable for patients most in need,” said Professor Chow.

“When we find treatments that are this effective, simple and safe we must do our best to get them to those who can benefit most.”

Professor Chow said a simple and effective combination quadpill strategy had potential to impact people’s lives worldwide. “High blood pressure is the leading cause of preventable deaths globally – we hope our world-leading findings will be translated swiftly into a product available for the general public,” she concluded.

Source: The University of Sydney

Japanese Traditional Sweets

Crane Wagashi of Toraya in Akasaka, Japan

The sweet is made of Chinese Yam with Sweet Bean Paste filling. The price is 1,080 yen (tax included) for a box of 4 pieces.

Daily Coffee May Protect the Heart

Steven Reinberg wrote . . . . . . . . .

The latest buzz on coffee? It may be good for your heart, a new, large study suggests.

Drinking light to moderate amounts — up to three cups a day — may lower the risk of stroke, fatal heart disease and all-cause death, researchers found.

“Regular coffee consumption of up to three cups per day is associated with a lower risk of all-cause mortality, cardiovascular mortality and stroke,” said lead researcher Dr. Judit Simon, from the Heart and Vascular Center at Semmelweis University in Budapest, Hungary.

These benefits might be partly explained by positive alterations in heart structure and function, she said.

Better yet, all types of coffee — caffeinated, decaf, brewed and instant — may offer heart benefits, Simon said.

“In a sub-analysis on types of mostly consumed coffee, decaffeinated coffee was associated with lower risk of all-cause and cardiovascular deaths, but not with lower stroke incidence, suggesting that caffeine is not the main or only component that is responsible for these favorable outcomes,” she said.

Instant coffee was associated with a lower risk of all-cause death, while ground coffee was linked with reduced risk of all-cause and cardiovascular death and lower stroke incidence, she said.

For the study, Simon and her colleagues collected data on nearly 470,000 men and women listed in the U.K. Biobank. At the study’s start, participants had no signs of heart disease and were an average age of 56. They were followed for up to 15 years.

Compared with non-coffee drinkers, those who drank light to moderate amounts had a 12% lower risk of all-cause death. Their odds for stroke were reduced by 21% and fatal heart disease by 17%, the researchers found, though only an association rather than a cause-and-effect link was seen.

The findings remained after the researchers accounted for age, sex, weight, height, smoking status, physical activity, high blood pressure, diabetes, cholesterol, income and diet.

Using cardiac MRIs, Simon’s group also looked at the effect daily coffee consumption had on the structure and function of the heart among nearly 31,000 people who were followed for 11 years on average.

They found that compared with not drinking coffee regularly, those who drank coffee daily had healthier, better-functioning hearts.

One U.S. heart expert looked over the findings.

“A significant number of observational studies have suggested that regular consumption of coffee is associated with lower risk of cardiovascular events, cardiovascular death and all-cause mortality,” said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles.

These findings add to the body of evidence that coffee consumption, even three to five cups a day, appears to be safe and associated with cardiovascular benefits, he said.

“Potential mechanisms which may account for potential benefits include improved insulin sensitivity, reduced inflammation, improved liver function and antioxidant effects,” Fonarow said. “However, it is important to note that these findings have not been established by prospective randomized clinical trials, so should be interpreted with caution.”

The findings were presented online at the annual meeting of the European Society of Cardiology, but should be considered preliminary until published in a peer-reviewed medical journal. The study received no funding from the coffee industry.

Source: American Heart Association

Egg and Prosciutto Rolls in Aspic

Ingredients

8 eggs
8 slices lean prosciutto
1/2 cup gherkins
a few tablespoons mayonnaise
3-1/4 cups commercial or home-made aspic (see recipe below)
a few black olives and 1 slice lemon to garnish

Method

  1. Poach the eggs. Remove from the water with a slotted spoon, put them on a napkin and trim with a knife.
  2. When cold, place each egg on 1 slice prosciutto lightly spread with mayonnaise. Add a few thin slices gherkin, reserving 8 gherkins for decoration, and fold the prosciutto to make a roll.
  3. Arrange the rolls on a platter and pour over the cool but still liquid aspic.
  4. Put the platter in the refrigerator for a few hours, and, before serving, garnish with the reserved gherkins cut into fan shapes, pitted olives, and lemon.

Makes 4 to 6 servings.


Home-made Aspic Recipe

Ingredients

3 cups double-strength clarified turkey or chicken broth
1/4 cup white wine
3 envelopes unflavored gelatin dissolved in 1/4 cup cold water

Method

Heat the broth and wine to boiling point. Add the dissolved gelatin. Stir until melted. Cool.

Makes 3-1/4 cups

Source: The Cook’s Book


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