American Heart Association Advocates for Single-Pill Combination Medications to Improve Hypertension Treatment

A new scientific statement from the American Heart Association suggests that single-pill combination medications for high blood pressure could simplify treatment, improve cardiovascular outcomes, and reduce long-term healthcare costs. The statement, published in the Association's journal Hypertension, details clinical evidence supporting these combination therapies.

Nearly half of U.S. adults, approximately 122 million people, have high blood pressure according to the 2025 American Heart Association Statistical Update. High blood pressure remains the leading modifiable risk factor for cardiovascular disease and contributes to heart attack, stroke, heart failure, kidney disease, and cognitive decline. The recently published 2025 AHA/ACC High Blood Pressure Guidelines recommend beginning treatment with two medications at once for stage 2 hypertension, 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 benefits of combination medications. Simplified treatment with fewer pills helps patients take medications more consistently, leading to faster achievement of blood pressure targets. Observational studies with follow-up periods of 1-5 years have linked single-pill combination medication use with a 15%-30% lower risk of major adverse cardiovascular events, including heart attack, stroke, heart failure-related hospitalizations, and death. Prevention of these events is associated with improved quality of life.

Cost considerations also favor combination therapies. 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 have found that combination pills are more cost-effective than taking the same medications in separate pills, potentially lowering healthcare costs for patients and organizations over time.

Despite these advantages, barriers to widespread adoption exist. Clinicians may have limited awareness of available combination therapies or concerns about reduced flexibility in dosage adjustments. Health insurance coverage and higher out-of-pocket costs for patients also restrict use, with many insurers requiring equivalent combinations prescribed as separate pills despite evidence demonstrating cost-effectiveness.

More research is needed to evaluate single-pill combination medications for people at higher cardiovascular risk, including those with resistant or secondary hypertension, chronic kidney disease, Type 1 or Type 2 diabetes, heart failure, and older adults. Currently, there are approximately 200 unique combinations of blood pressure medications 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."