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TOPLINE:

Despite guideline recommendations in 2017 and 2025, fewer than 1 in 10 US adults with a new diagnosis of hypertension were started on single-pill combination therapy. Prescriptions did not increase over the 10-year study period, as per a brief report published in the Journal of the American College of Cardiology (JACC).

METHODOLOGY:

• Researchers conducted a retrospective observational study using the Epic Cosmos electronic health record database to assess how often adults newly diagnosed with hypertension were started on single-pill combination therapy.
• They included over 7.2 million US adult patients newly diagnosed with hypertension between 2015 and 2025.
• Patients had at least 1 year of prior records and initiated antihypertensive medications such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers, or diuretics.
• The primary outcome was the initiation of a single-pill combination, defined as a fixed-dose pill containing two or more antihypertensive agents, compared with that of separate-pill combinations or monotherapy.
• Prescriptions were tracked quarterly between 2015 and 2025. A sensitivity analysis focused on patients with confirmed stage 2 hypertension, defined as at least two blood pressure readings ≥ 140/90 mm Hg.

TAKEAWAY:

• Over the study period, 5.88% of patients were started on single-pill combination therapy, 7.79% were started on separate-pill combinations, and 86.33% were started on monotherapy.
• The quarterly initiation of single-pill combination therapy declined by 6.56% per year (P < .001) after peaking at 9.94% in early 2015. In contrast, the initiation of separate-pill combinations and monotherapy increased by 2.10% and 0.31% per year, respectively (P < .001 for both).
• In patients with stage 2 hypertension, the initiation of single-pill combination therapy was even lower at 5.46% and use decreased from 9.06% in 2015 to 4.79% by 2025.
• The initiation of single-pill combination therapy with ACE inhibitors-diuretics declined sharply over the decade. By late 2022, ARB-diuretic combinations had become the most frequently prescribed single-pill combination.

IN PRACTICE:

“[The study] findings highlight a persistent disconnect between guideline recommendations and routine clinical practice,” the researchers wrote.

“Strategies such as clinical decision support tools, simplified treatment algorithms, and health system-level initiatives may help facilitate the routine use of combination therapy when clinically appropriate,” they added.

SOURCE:

The study was led by Kyungseon Choi, PharmD, PhD, of Yale School of Medicine in New Haven, Connecticut. It was published online on May 6 as a brief report in the JACC.

LIMITATIONS:

The authors did not have a dedicated limitations section in this brief report.

DISCLOSURES:

The study received support from the National Institutes of Health. Several authors reported research funding from government, nonprofit, and industry sources; institutional research support; advisory or consulting fees; equity or co-founder roles in health-technology firms; unpaid service on an open-access board; and institutional contracts with pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.