NEW IDEAS FOR HIGH BLOOD PRESSURE

As I’ve written many times previously, procedures, protocols, and treatments in medical care change constantly. Medical research publications are filled with new ideas substantiated by scientific studies. New drugs, new drug combinations, and new treatment regimens are ideas and realities that challenge a doctor’s ability to keep current.

The treatment of high blood pressure is one area where a huge shift in thought has occurred. Until recently, high BP was treated in a laborious step-wise progression of prescribing one drug after another, running up the dose of each drug before starting another. It was slow and expensive for the patient. 

Now, doctors are able to short-cut the treatment process by prescribing drugs that contain three, or even four, different types of BP lowering drugs. This gets to the business of lowering BP quicker and more physiologically. In spite of it hitting high BP from several different approaches, combination drugs can be a bit cumbersome to prescribe. For example, if the patient has dizziness after being prescribed drug ABC, is it caused by component A, B, or C? You just don’t know. 

The major blood pressure lowering drugs can be placed in 7 different classes. They are:

    DIURETICS (D)

    BETA ADRENERGIC RECEPTOR BLOCKERS (BB)

    ANGIOTENSIN CONVERTING ENZYME INHIBITORS (ACEI)

    ANGIOTENSIN RECEPTOR BLOCKERS (ARB)

    CALCIUM CHANNEL BLOCKERS (CCB)

    ALPHA RECEPTOR BLOCKERS

    VASODILATORS

    ALDOSTERONE AGONISTS

    DIRECT RENIN INHIBITORS

    CENTRAL ACTING AGENTS

The first five drug classes are the most often prescribed and most effective, and used most often in combination drugs. Examples of three-drug combinations contain 

     ARB + CCB + D     OR     ACEI + BB + D

Two four-drug combinations have recently become available. They promise to change the whole BP treatment landscape. These two drugs are baxdrostat and aprocitentan. The drug manufacturers and treatment specialists are calling these Quadpills.

Baxdrostat:  ARB + CCB + D + BB

Aprocitentan:   ACEI + CCB + D + BB

So when you see your doctor for your BP he might say we have these new combo drugs that we could try. BUT if you’re already doing well, have controlled BP on another drug combination, and aren’t spending an arm and a leg for your meds, the “if it ain’t broke don’t fix it” policy takes over. I would use these combo drugs for patients with new onset HBP or who have difficult-to-control BP. 

Reference: Richeux V. Quadpill Strategy Gains Ground in Hypertension Medscape 2026 February 13.