A new scientific statement published in the American Heart Association's journal Hypertension details how single-pill combination medications could transform hypertension management by simplifying treatment and improving long-term health outcomes. The statement, titled "Single-Pill Combination Therapy for the Management of Hypertension," emphasizes that these combination pills help adults with high blood pressure achieve target levels faster than taking multiple separate medications daily.
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 attack, stroke, heart failure, kidney disease, and cognitive decline. The recently published 2025 AHA/ACC High Blood Pressure Guideline recommends beginning treatment for stage 2 hypertension with two medications at once, preferably in 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 identifies several key benefits of combination medications. Simplified treatment protocols help patients take medications as directed more consistently, while streamlined prescribing reduces clinician uncertainty about medication selection and dosage. Observational studies with follow-up periods of 1-5 years link 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.
Economic implications are significant, with the 2025 Heart Disease and Stroke Statistics reporting annual direct and indirect costs of cardiovascular disease in the United States at an estimated $417.9 billion. Recent studies indicate combination pills are more cost-effective than taking equivalent medications separately, potentially lowering healthcare costs for patients and organizations over time.
Despite these advantages, barriers to widespread adoption persist. Clinician awareness of available combination therapies remains limited, and concerns about reduced dosage flexibility present prescribing challenges. Insurance coverage restrictions, including requirements by Medicare and Medicaid for equivalent separate-pill combinations despite evidence of cost-effectiveness, create affordability and accessibility issues for patients.
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."
