Single-Pill Blood Pressure Combinations May Improve Heart Health and Reduce Costs

Single-pill medications combining two or more blood pressure drugs may simplify treatment and help more adults with hypertension achieve target blood pressure levels faster while maintaining long-term control compared to patients taking multiple separate pills daily. According to a new scientific statement published in the American Heart Association's journal Hypertension, this approach is linked to reduced risks of heart attack, stroke, heart failure-related hospitalizations and death, along with improved quality of life and lower long-term costs for patients and the healthcare system.

Nearly half of U.S. adults, approximately 122 million people, have high blood pressure according to the 2025 American Heart Association Statistical Update. Hypertension represents the leading modifiable risk factor for cardiovascular disease and contributes significantly to heart attack, stroke, heart failure, kidney disease, cognitive decline and dementia. The recently published 2025 AHA/ACC High Blood Pressure Guideline recommends combining healthy lifestyle behaviors with early treatment using one or more blood pressure medications when necessary. For individuals with stage 2 hypertension (blood pressure levels 140/90 mm Hg or higher), the guideline specifically recommends beginning treatment with two medications simultaneously, 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 clarifies that single-pill combination medications differ from "polypills," which combine blood pressure medications with statins and/or aspirin to reduce cardiovascular risk for patients requiring multiple preventive therapies. Currently, less than 50% of U.S. adults diagnosed and treated for hypertension achieve the recommended blood pressure goal of less than 130/80 mm Hg, despite several effective medication types being available including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers and thiazide-type diuretics.

Benefits of combination medications include simplified, faster treatment through reduced pill burden, streamlined prescribing processes for clinicians, and improved long-term heart health. Observational studies with follow-up periods ranging from one to five years have linked single-pill combination medication use with a 15%-30% lower risk of major adverse cardiovascular events. Prevention of these events is associated with longer and improved quality of life. Additionally, combination pills demonstrate greater cost-effectiveness than taking equivalent medications separately, potentially helping reduce the estimated $417.9 billion annual direct and indirect costs of cardiovascular disease in the United States.

Despite these advantages, barriers to widespread adoption persist. Clinicians may have limited awareness of available combination therapies and concerns about reduced flexibility in dosage adjustments. Health insurance coverage restrictions and higher out-of-pocket costs also limit accessibility, with many insurers including Medicare and Medicaid continuing to require equivalent combinations prescribed as separate pills despite evidence supporting combination medication cost-effectiveness. More research is needed to evaluate safety and effectiveness 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 by patients in the U.S., with the four most commonly used medications available as single-pill combinations. Expanding options for medications combined within single-pill formulations and developing additional triple and quadruple combinations may further simplify treatment and improve patient outcomes. "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 noted. "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."