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

The American Heart Association has issued a scientific statement advocating for single-pill combination medications as a more effective approach to managing high blood pressure, a condition affecting approximately 122 million U.S. adults according to the 2025 American Heart Association Statistical Update. Published in the Association's journal Hypertension, the statement details clinical evidence supporting these combination therapies, which align with the recently published 2025 AHA/ACC High Blood Pressure Guidelines recommending beginning treatment with two medications at once for stage 2 hypertension, preferably in a single combination pill.

High blood pressure remains the leading modifiable risk factor for cardiovascular disease, contributing to heart attack, stroke, heart failure, kidney disease, and cognitive decline. Jordan B. King, Pharm.D., M.S., chair of the scientific statement writing group, explained that most people with high blood pressure need two or more medications to reach target blood pressure levels, but taking multiple pills daily can be confusing or difficult to maintain. Single-pill combination medications serve as valuable tools to manage this condition, with individuals taking them achieving optimal blood pressure levels sooner than those taking the same medications in separate pills.

The statement identifies several significant 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 for patients.

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. King emphasized that better blood pressure control in the long run lowers healthcare costs for patients and society while enhancing quality of life and improving health outcomes for millions.

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. 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.

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. King concluded that if single-pill combinations were the norm rather than the exception, there could be meaningful improvement in blood pressure control across the population, significantly reducing the risk of heart attacks and strokes.