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Jul 18, 2017

Low-Dose Medications are Promising for Patients with High Blood Pressure

Combined low-dose medications may be preferable for patients with high blood pressure, study finds.

Combining several low doses of blood pressure drugs may be preferable for some patients with hypertension (high blood pressure), based on a recent study that links low-dose blood pressure medications to fewer side effects and complications.

Published in the American Heart Association journal Hypertension, this study analyzed all available evidence on low-dose blood pressure medication.  The goal was to see whether prescribing lower doses helps maximize benefits and minimize side effects of blood pressure drugs.

Minimizing side effects is especially important for patients with high blood pressure, since high blood pressure requires long-term treatment and medication adherence. While one in three American adults has high blood pressure, only half of patients with high blood pressure have their condition under control. It’s likely that better medication adherence would improve blood pressure management and outcomes.  

A total of 42 clinical trials were included in the analysis, which included 20,284 adults with high blood pressure. Studies tested multiple combinations of medications, including calcium channel blockers, beta blockers, angiotensin receptor blockers, angiotensin-converting enzyme (ACE) inhibitors and thiazide diuretics, all of which are commonly used to treat hypertension. Study participants were assigned to varying treatments, ranging from a placebo with no active medication to a low-dose (one-quarter of the standard prescribed dose) or standard full-dose of medication.

After an average of seven weeks, researchers found that a single low-dose medication resulted in a significant reduction in blood pressure compared to the inactive placebo. However, the more types of low-dose medication participants took, the larger the average blood pressure reduction was. For example, participants taking two low-dose medications had an average blood pressure reduction of 6.7/4.4 mmHg, while those taking four drugs had an average blood pressure reduction of 22.4/13.1 mmHg.

Low-dose medications did not appear to increase risk for adverse events compared to the placebo drug and adverse events were significantly less common compared to the standard dose.

However, authors also note that taking one or two low-dose medications was not as effective in lowering blood pressure when compared to taking a single, full dose.

Findings are promising, as effectively treating patients with high blood pressure remains a challenge. Many patients with high blood pressure are already taking medication but don’t have their condition under control. For patients with poor blood pressure control, it’s possible that using a combination of low-dose medications may serve as a useful alternative to standard treatment.

However, authors note that additional research is needed to better understand which patients stand to benefit most from this treatment strategy. In the meantime, experts encourage providers to discuss this treatment option with patients, especially with patients that struggle with side effects and complications.

Questions for You to Consider

  • What is hypertension?
  • Hypertension, often referred to as high blood pressure, occurs when the force of blood against the artery walls is too high. High blood pressure is often referred to as the “silent killer,” because it often causes no symptoms and if left uncontrolled, increases risk for heart attack and stroke.
  • What is a healthy blood pressure?

  • For adults, a healthy blood pressure is less than 120/80 mmHg. Blood pressure is considered elevated between 120–139 mmHg systolic (top number) or between 80–89 mmHg diastolic. Chronic high blood pressure, known as hypertension, occurs when systolic blood pressure is more than 140 mmHg or the diastolic systolic blood pressure is more than 90 mmHg.


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