Single-Pill Combination Therapy for the Management of Hypertension: A Scientific Statement From the American Heart Association
Jordan B. King, Jaejin An, Brandon K. Bellows, Jordana B. Cohen, Yvonne Commodore‐Mensah, Lama Ghazi, Aisha T. Langford, Robert D. Brook
Abstract
The growing global burden of hypertension and inadequate blood pressure control necessitate effective therapeutic strategies to improve blood pressure management and reduce the risks of cardiovascular diseases attributable to hypertension. Single-pill combination medications for hypertension combine ≥2 antihypertensive agents in a single tablet. Single-pill combination medications offer a promising opportunity to achieve faster and more sustained blood pressure control compared with stepped care (ie, prescribing antihypertensive monotherapy, titrating the dose, and later adding more antihypertensive agents). Single-pill combination medications combine complementary mechanisms of action of antihypertensive agents to more effectively lower blood pressure while reducing adverse effects. This approach simplifies treatment regimens by lowering pill burden, improves patient adherence, overcomes clinician inertia by simplifying prescribing, is cost-effective, and results in faster blood pressure control compared with using separate pills. Minor limitations of single-pill combination medications include constrained flexibility for dosing adjustments and lack of commercial availability of certain combinations of agents. By incorporating single-pill combination medications into routine practice for most patients with hypertension, health care professionals may improve long-term cardiovascular outcomes while reducing patient burden. This scientific statement provides an overview of the clinical evidence surrounding the use of single-pill combination medications for hypertension, strategies to implement single-pill combination medications into clinical practice, and knowledge gaps that merit further investigation.