Abstract:
:High blood pressure is the leading cause of preventable morbidity and mortality globally. Many patients remain on single-drug treatment with poor control, although guidelines recognize that most require combination therapy for blood pressure control. Our hypothesis is that a single-pill combination of 4 blood pressure-lowering agents each at a quarter dose may provide a simple, safe, and effective blood pressure-lowering solution which may also improve long-term adherence. The Quadruple UltrA-low-dose tReaTment for hypErTension (QUARTET) double-blind, active-controlled, randomized clinical trial will examine whether ultra-low-dose quadruple combination therapy is more effective than guideline-recommended standard care in lowering blood pressure. QUARTET will enroll 650 participants with high blood pressure either on no treatment or on monotherapy. Participants will be randomized 1:1 and allocated to intervention therapy of a single pill (quadpill) containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg or to control therapy of a single identical-appearing pill containing irbesartan 150 mg. In both arms, step-up therapy of open-label amlodipine 5 mg will be provided if blood pressure is >140/90 at 6 weeks. The primary outcome is the difference between groups in the change from baseline in mean unattended automated office systolic blood pressure at 12-week follow-up. The primary outcome and some secondary outcomes will be assessed at 12 weeks; there is an optional 12-month extension phase to assess longer-term efficacy and tolerability. Our secondary aims are to assess if this approach is safe, has fewer adverse effects, and has better tolerability compared to standard care control. QUARTET will therefore provide evidence for the effectiveness and safety of a new paradigm in the management of high blood pressure.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Chow CK,Atkins ER,Billot L,Chalmers J,Hillis GS,Hay P,Neal B,Nelson M,Patel A,Reid CM,Schlaich M,Usherwood T,Webster R,Rodgers Adoi
10.1016/j.ahj.2020.09.017subject
Has Abstractpub_date
2021-01-01 00:00:00pages
56-67eissn
0002-8703issn
1097-6744pii
S0002-8703(20)30273-8journal_volume
231pub_type
杂志文章,多中心研究,随机对照试验abstract::The efficacy and safety of once-daily administration of the new angiotensin-converting enzyme inhibitor quinapril or quinapril plus hydrochlorothiazide (HCTZ) were assessed in 64 older (greater than 65 years) patients with mild to moderate hypertension in an uncontrolled, open-label study. Treatment was initiated with...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(92)91065-9
更新日期:1992-05-01 00:00:00
abstract::Noninvasive risk assessment in survivors of AMI can effectively subdivide patients into groups with differing risk profiles after hospital discharge, but some patients at risk for late death or recurrent AMI may be incorrectly identified; data from cardiac catheterization and angiography provide complementary and gene...
journal_title:American heart journal
pub_type: 社论
doi:10.1016/0002-8703(91)90747-6
更新日期:1991-02-01 00:00:00
abstract:BACKGROUND:Protease-activated receptor 1 antagonism with vorapaxar represents a novel strategy for platelet inhibition. In TRACER, vorapaxar was compared with placebo plus standard of care among 12,944 patients with non-ST-segment elevation acute coronary syndromes. We anticipated that most patients would have received...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2014.09.002
更新日期:2014-12-01 00:00:00
abstract::We discuss the anatomy, physiology, and pathophysiology of epicardial adipose tissue and its relationship to coronary atherosclerosis. Epicardial fat stores triglyceride to supply free fatty acids for myocardial energy production and produces adipokines. It shares a common embryological origin with mesenteric and omen...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2007.03.019
更新日期:2007-06-01 00:00:00
abstract::The American Cancer Society's prospective study of 1 million Americans was analyzed to determine whether coronary heart disease (CHD) mortality rates by cigarette smoking in blacks differed from those in whites. More than 22,000 blacks were followed up for nearly 200,000 person-years in the 12-year study, 1960-1972. A...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90675-6
更新日期:1984-09-01 00:00:00
abstract:BACKGROUND:As stenting practice has evolved to include greater numbers of stents and adjunctive balloon catheters per case, concern has focused on the increasing costs of equipment for the delivery of stents. METHODS AND RESULTS:To evaluate temporal changes in costs of intracoronary stenting, we examined total costs, ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70193-0
更新日期:1998-07-01 00:00:00
abstract::To compare the effects of two thrombolytic agents, streptokinase and recombinant tissue-type plasminogen activator (rTPA) with early heparinization, on left ventricular function, coronary patency and reinfarction rates, bleeding complications, and short- and long-term mortality, we studied 122 patients with acute myoc...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(92)90685-o
更新日期:1992-04-01 00:00:00
abstract::There are selective blocking agents (antagonists) for alpha receptors and beta receptors. These blocking agents prevent the response to injected agonists and neurogenically released norepinephrine. The principal cardiovascular response to alpha blockade is postural hypotension with reflexly induced cardiac stimulation...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80020-8
更新日期:1976-12-01 00:00:00
abstract::In 14 patients with severe congestive heart failure, the effects of captopril on the forearm circulation were evaluated with strain gauge plethysmography. Changes in plasma renin activity, angiotensin II, norepinephrine, epinephrine, bradykinin, prostaglandin E2, and 6-keto-prostaglandin F1 alpha concentrations were a...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90662-5
更新日期:1989-01-01 00:00:00
abstract::Traditionally, assessment of therapy has been judged by the ability of treatment to alleviate symptoms with tolerable side effects or toxicity. In recent years, it has become obvious that more subtle and patient-oriented approaches are urgently needed to evaluate progression of cardiovascular disease and to monitor th...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90963-x
更新日期:1987-07-01 00:00:00
abstract::Angina pectoris before and after MI was evaluated in a sample of 729 men and women from a general population in whom MI developed during a 36-year period of follow-up. Relations of AP to subsequent CHD events and mortality after initial MI were analyzed by proportional hazards regression models and were adjusted for c...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90406-8
更新日期:1996-07-01 00:00:00
abstract::Two patients with isolated T wave alternans are reported, with their vectocardiograms, their response to carotid sinus stimulation, and the response to calcium infusion in one of them with documented severe hypocalcemia. Eleven cases of the literature are briefly reviewed. The alternans of the T wave appears with seve...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90369-1
更新日期:1978-03-01 00:00:00
abstract:BACKGROUND:Enhanced external counterpulsation (EECP) reduces angina and extends time to exercise-induced ischemia in patients with symptomatic coronary disease. One- and two-center studies and a retrospective case series reported that EECP improves myocardial perfusion in stable angina pectoris. We sought to critically...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2005.01.054
更新日期:2005-11-01 00:00:00
abstract::The acute effects of diltiazem on coronary reactive hyperemia were studied in 12 patients with flow-limiting coronary stenosis. Reactive hyperemia was elicited by injection of 8 ml contrast medium into the left coronary artery, while coronary sinus blood flow and left ventricular and aortic pressures were continuously...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90353-4
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:Erectile dysfunction (ED) is a common disorder in middle-aged men and is significantly influenced by cardiovascular risk factors (CVRFs) and cardiovascular disease. The substudy of the ONTARGET/TRANSCEND trials evaluates the relationship of erectile function to baseline characteristics and current treatment ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2007.03.024
更新日期:2007-07-01 00:00:00
abstract::Therapeutics involves the careful balance between treatment disadvantages and advantages--the so-called risk-benefit ratio. Even after 20 years beta-blockers must be selected carefully to suit the patient's needs. This review examines several problems associated with beta-blockade. Generally, beta1-cardioselectivity i...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(88)90130-5
更新日期:1988-11-01 00:00:00
abstract:BACKGROUND:The human KCNE1 protein forms the β-subunit of the IKs potassium channel and is important in the regulation of the atrial action potential duration. The purpose of this study was to investigate the association between the nonsynonymous 112G>A mutation of the KCNE1 gene and postcardiac surgery atrial fibrilla...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2013.09.020
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:The Total Occlusion Study of Canada (TOSCA) is a multicenter, randomized trial evaluating the effect of stenting with > =1 heparin-coated stent on long-term patency after percutaneous coronary intervention by balloon angioplasty of occluded coronary arteries. The purpose of the current study was to compare t...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1067/mhj.2001.116960
更新日期:2001-08-01 00:00:00
abstract::Although it has been shown that early cardiac rejection can be visualized by radioimmunoscintigraphy targeting major histocompatibility complex class II antigen, the use of antibodies that bind to a polymorphic determinant of class II antigen has certain disadvantages for clinical application. This investigation was d...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90050-7
更新日期:1994-05-01 00:00:00
abstract::The relationship between coronary artery size and left ventricular (LV) muscle mass was studied in 10 control subjects and in 10 patients with chronic mitral regurgitation before and 28 +/- 15 months after mitral valve surgery. Left and right coronary artery size was determined by quantitative coronary arteriography. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90659-w
更新日期:1993-11-01 00:00:00
abstract::A 17-year-old man with staphylococcal endocarditis of the mitral valve developed an infective aneurysm of the posterior left ventricular wall. Echocardiography revealed an echo-free space posterior to the posterior left ventricular wall. This echo-free space undoubtedly represented the aneurysmal sac, because it could...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90051-0
更新日期:1978-09-01 00:00:00
abstract::A counterimmunoelectrophoresis technique for detection of serum myoglobin (Mb) was improved using non-ionic polymer dextran. Precipitin lines were graded according to their strength, which was ascertained by radioimmunoassay data. By this method, serum Mb in concentrations of 500 ng./ml. before stain and of 200 ng./ml...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90084-4
更新日期:1978-08-01 00:00:00
abstract::To elucidate the long-term outcome and frequency of complications after heart transplantation for peripartum cardiomyopathy (PPCM), we compared the courses of eight consecutive patients undergoing transplantation for PPCM with those of nine female age-matched control subjects undergoing transplantation for idiopathic ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90051-5
更新日期:1994-05-01 00:00:00
abstract::Free fatty acids (FFA), the predominant myocardial energy substrate, are present in increased quantities immediately following acute myocardial infarction (AMI) and may cause deleterious alterations in cardiac rhythm, oxygen consumption, and mechanical performance. In an attempt to suppress FFA and simultaneously incr...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-8703(76)80043-9
更新日期:1976-10-01 00:00:00
abstract::Release of thromboxane (TXA2) during acute myocardial infarction may be an important contributing factor in the genesis of ventricular fibrillation (VF). We assessed the effect of selective TXA2 inhibition on vulnerability to VF after total occlusion of the anterior descending coronary artery in chloralose-anesthetize...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90099-2
更新日期:1986-04-01 00:00:00
abstract::Heart rate responses to three different procedures (amyl nitrite inhalation, standing up, and isoproterenol infusion), were studied before and during acute adrenergic beta blockade with intravenous propranolol in three normal and six hypertensive subjects. Propranolol decreased, but did not completely abolish, the hea...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90125-4
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND:Anemia in heart failure is both common and associated with worse symptoms and increased mortality. Several small randomized controlled trials (RCTs) have assessed erythropoiesis-stimulating agents (ESAs), but definitive evaluation and clinical guidance are required. We sought to systematically review the eff...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2011.02.013
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Patients with left ventricular dysfunction who undergo coronary artery bypass graft (CABG) surgery frequently have late sudden cardiac death. The CABG Patch Trial is a prospective, randomized, multicenter clinical trial that randomized patients at high risk at the completion of CABG surgery to implantation o...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-8703(97)80001-4
更新日期:1997-11-01 00:00:00
abstract::The appearance of perivalvular cavities (PCs) in patients with infectious endocarditis (IE) was studied by transesophageal echocardiography (TEE) color Doppler examinations to determine whether the color Doppler TEE presentation was in keeping with the current concept of PCs representing abscesses. Two heart centers p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90241-4
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Implantable cardioverter defibrillators (ICDs) effectively prevent sudden cardiac death, but selection of appropriate patients for implantation is complex. We evaluated whether risk stratification based on risk of sudden cardiac death alone was sufficient to predict the effectiveness and cost-effectiveness o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.125501
更新日期:2002-09-01 00:00:00