A new scientific statement from the American Heart Association, published in the journal Hypertension, indicates that single-pill combination medications for high blood pressure may simplify treatment and improve long-term health outcomes. The statement, titled "Single-Pill Combination Therapy for the Management of Hypertension," reviews clinical evidence showing that combining two or more blood pressure medications into one pill can help patients achieve target blood pressure levels faster and maintain them longer than taking multiple separate pills.
According to the 2025 American Heart Association Statistical Update, nearly half of U.S. adults—about 122 million people—have high blood pressure, defined as 130/80 mm Hg or higher. High blood pressure is the leading modifiable risk factor for cardiovascular disease and a major cause of heart attack, stroke, heart failure, kidney disease, and cognitive decline. The recently published 2025 AHA/ACC High Blood Pressure Guideline recommends starting treatment with two medications simultaneously for individuals with stage 2 hypertension (140/90 mm Hg or higher), preferably in a single combination pill.
"Most people with high blood pressure need two or more medications to reach target blood pressure measurements; however, taking multiple pills each day can be confusing or hard to keep up with," said Dr. Jordan B. King, chair of the statement writing group. "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 benefits of combination therapy include simplified and faster treatment, streamlined prescribing for clinicians, improved long-term heart health, and lower costs. Observational studies have linked single-pill combination use with a 15% to 30% lower risk of major adverse cardiovascular events such as heart attack, stroke, and heart failure-related hospitalizations. Improved blood pressure control could reduce the estimated $417.9 billion annual cost of cardiovascular disease in the U.S.
Despite these advantages, barriers to widespread adoption remain. Clinicians may have limited awareness of available combination therapies or concerns about dosage flexibility. Insurance coverage and higher out-of-pocket costs can also restrict access. Many insurers, including Medicare and Medicaid, often require separate pills despite evidence of cost-effectiveness for combinations. Additionally, more research is needed for high-risk populations such as those with resistant hypertension, chronic kidney disease, diabetes, or heart failure.
"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 added. The statement notes that expanding options for combination pills and developing additional triple and quadruple combinations could further simplify treatment and improve outcomes for the millions of people with high blood pressure.
