A single pill consisting of two or more medications may help hypertension patients lower blood pressure (BP), reduce risk for heart attack and stroke, and improve long-term adherence, according to a new American Heart Association (AHA) scientific statement.

The benefits stem simply from taking just one pill instead of several, said Robert D. Brook, MD, co-author of the statement and director of Cardiovascular Prevention and a professor of medicine at Wayne State University in Detroit.

“This eases treatment, improves long-term adherence, and leads to earlier, more stable, and sustained control,” Brook told Medscape Medical News. These medications are formulated at dosages based on clinically-proven combination strategies, “thus preventing under-dosing and suboptimal multidrug regimens,” he said. “Together, these factors can translate into decreased cardiovascular morbidity and mortality.”

Improved Adherence 

Nearly half of US adults have elevated BP, defined as a measurement of 130/80 mm Hg or higher, according to the AHA. High BP is a leading cause of heart attack, stroke, heart failure, kidney disease, cognitive decline, and dementia. It is also the leading modifiable risk factor for cardiovascular disease.

The 2025 AHA/ACC High Blood Pressure Guideline recommends combining healthy lifestyle behaviors and early treatment with one or more medications to lower BP. For people at 140/90 mm Hg or higher, the guideline suggests initiating treatment with two medications simultaneously, preferably in a single combination pill.

Convenience is a major help to many patients, said Luke J. Laffin, MD, co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic and associate professor of medicine at Cleveland Clinic Lerner College of Medicine of Case Western.

“Patients do not like taking multiple pills per day,” said Laffin, who was not part of the statement writing team. “They are more likely to have the dose increased when taking a fixed-dose combination pill, rather than having drugs prescribed separately.” 

There is no difference in outcomes if patients prescribed multiple-pill treatments take exactly the same medications and same dose as those who are prescribed a single-pill combination, Laffin noted. “However, many patients do not take all their medications,” he said. “Therefore, single-pill regimens help improve adherence and help combat prescriber inertia.” 

Cost-Effectiveness 

One other motivation for patients is cost-effectiveness, Brook said, as many combination pills are available as generic and inexpensive formulations. “The overall evidence supports that improved BP control afforded by [combination pills] further reduces financial burdens on the healthcare system,” he said. 

Starting hypertension treatment with these pills rather than using older approaches

such as stepped-care — initiating a single medication and increasing the doses and number of add-on medications as needed over time — results in earlier BP control, Brook said. He noted that several trials have shown the combination pills achieve rapid and sustained BP control compared with stepped-care approaches. 

“Stepped-care approaches often fail to reach the required therapeutic intensity needed to achieve BP control. These approaches complicate the patient journey, requiring multiple clinic visits and medication adjustments to arrive at the same treatment,” he said.

More research is needed to understand the impact of combination pills for people who are at high risk for cardiovascular disease and those with resistant or secondary hypertension or other chronic conditions such as kidney disease, diabetes, or heart failure, Brook said. 

Brook has no financial disclosures. Laffin serves or has served on steering or advisory committees for Recor, Medtronic, Eli Lilly, Novartis, Novo Nordisk, and Ripple Medical. His institution has received research funding from AstraZeneca, Arrowhead, Crispr Therapeutics, Kardigan, Mineralys, and Retension. Laffin receives royalties from Belvoir Media Group and Elsevier. 

Martta Kelly is a medical journalist living in metropolitan New York.