Top Things to Know: Single Pill Combination Therapy for the Management of Hypertension
Published: December 15, 2025
Prepared by Jordan B. King, PharmD, MSCI and Robert Brook, MD
- Hypertension control remains poor despite effective therapies, with fewer than 25% of US adults achieving blood pressure <130/80 mm Hg.
- Most patients require two to four antihypertensive medications to achieve guideline-directed blood pressure goals.
- Single-pill combination medications (SPCMs) improve adherence and persistence, accelerate blood pressure control and lead to more sustained blood pressure reductions compared with equivalent free-pill regimens.
- Initial treatment of hypertension with SPCMs is recommended for most patients requiring medications, including those with stage 1 hypertension.
- SPCMs combining renin-angiotensin system blockers with calcium channel blockers are the preferred first choice for most patients.
- Observational studies associate SPCM use with a 15–30% lower incidence of major adverse cardiovascular events compared with free-pill combinations, although more robust randomized clinical trial evidence is needed.
- SPCMs are cost-effective or even cost-saving in many settings by preventing cardiovascular events, improving quality of life, and increasing quality-adjusted life years.
- Barriers to SPCM use include restrictive insurance coverage, higher out-of-pocket costs, prescriber concerns about dose flexibility, and limited commercial availability of certain combinations.
- SPCMs may help improve hypertension control by simplifying treatment regimens, although access barriers remain for low-income, Medicaid, and certain populations such as Black adults.
- Future directions include the development of triple and quadruple SPCMs and cardiovascular polypills, which may further simplify therapy and improve outcomes.
Citation
King JB, An J, Bellows BK, Cohen JB, Commodore-Mensah Y, Ghazi L, Langford AT, Brook RD; on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Single-pill combination therapy for the management of hypertension: a scientific statement from the American Heart Association. Hypertension. Published online December 15, 2025. doi: 10.1161/HYP.0000000000000258