Single-Pill Blood Pressure Combinations May Improve Treatment Adherence and Cardiovascular Outcomes

A new scientific statement published in the American Heart Association's journal Hypertension details how single-pill medications combining two or more blood pressure drugs could simplify treatment and improve long-term health outcomes for adults with hypertension. The statement, titled "Single-Pill Combination Therapy for the Management of Hypertension," outlines clinical evidence supporting these combination medications and identifies strategies for implementation in clinical practice.

According to the 2025 American Heart Association Statistical Update, nearly half of U.S. adults, approximately 122 million people, have high blood pressure. High blood pressure remains the leading modifiable risk factor for cardiovascular disease and contributes significantly to heart attacks, strokes, heart failure, kidney disease, and cognitive decline. The recently published 2025 AHA/ACC High Blood Pressure Guideline recommends beginning treatment with two medications simultaneously for people with stage 2 hypertension, preferably using a single combination pill.

"Most people with high blood pressure need two or more blood pressure medications to reach target blood pressure measurements; however, taking multiple pills each day can be confusing or hard to keep up with," said Jordan B. King, Pharm.D., M.S., chair of the scientific statement writing group. "Single-pill combination pills are valuable tools to manage high blood pressure. Individuals taking a single combination pill are able to achieve optimal blood pressure levels sooner than peers who take the same medications in separate pills."

The statement clarifies that single-pill combination medications differ from "polypills," which combine blood pressure medications with cholesterol-lowering statins and/or aspirin. Currently, less than 50% of U.S. adults being treated for hypertension achieve the recommended blood pressure goal of less than 130/80 mm Hg, highlighting the need for more effective treatment approaches.

Benefits identified in the statement include simplified and faster treatment, as managing fewer pills improves medication adherence. Observational studies with follow-up periods of 1-5 years have linked single-pill combination use with a 15%-30% lower risk of major adverse cardiovascular events, including heart attack, stroke, heart failure-related hospitalizations, and death. Improved blood pressure control also correlates with better quality of life and reduced long-term costs for both patients and the healthcare system.

According to the American Heart Association's 2025 Heart Disease and Stroke Statistics, the annual direct and indirect costs of cardiovascular disease in the United States were estimated at $417.9 billion. Recent studies indicate that combination pills are more cost-effective than taking equivalent medications as separate pills, suggesting potential economic benefits from wider adoption.

Despite these advantages, barriers to widespread use persist. Clinicians may have limited awareness of available combination therapies or concerns about reduced flexibility in dosage adjustments. Affordability and accessibility issues also present challenges, as many insurers, including Medicare and Medicaid, continue to require separate pill prescriptions despite evidence supporting combination medications' cost-effectiveness.

The statement notes that more research is needed to evaluate single-pill combinations for higher-risk populations, including individuals with resistant or secondary hypertension, chronic kidney disease, Type 1 or Type 2 diabetes, heart failure, and older adults. Currently, approximately 200 unique combinations of blood pressure medications are used in the U.S., with the four most commonly used medications available as single-pill combinations.

"If single-pill combinations were the norm rather than the exception, there could be a meaningful improvement in blood pressure control across the population, which could significantly reduce the risk of heart attacks and strokes," King said. "In the long run, better blood pressure control lowers health care costs for patients and society, enhances quality of life and improves health outcomes for the millions of people with high blood pressure."

The scientific statement was prepared by a volunteer writing group representing the American Heart Association's Council on Hypertension, the Council on Cardiovascular and Stroke Nursing, and the Council on Clinical Cardiology. While scientific statements outline current knowledge and identify research needs, they do not provide official treatment recommendations, which are contained in separate clinical practice guidelines.