Single-pill therapy achieves better long-term blood pressure control

Antihypertensive medications combined into a single pill lowered blood pressure more effectively than typical treatment with multiple pills for patients in Jamaica and Colombia, a study co-led by UT Southwestern Medical Center researchers shows.

The findings, shared during the Late-Breaking Science presentations at the 2026 American Heart Association Scientific Sessions and published concurrently in JAMA, establish the long-term effectiveness and safety of this approach for treating uncontrolled high blood pressure.

Our study demonstrated that a single-pill combination provided an effective, implementable, scalable, and sustainable approach for hypertension control in low- and middle-income countries. It improves patients' adherence to medication and satisfaction with medication and hypertension-related care. The trial also provides additional evidence for physicians to recommend this treatment to patients with high blood pressure in the U.S. and beyond."

Jiang He, M.D., M.S., Ph.D., Chair of Epidemiology, Peter O'Donnell Jr. School of Public Health and Professor of Internal Medicine and Neurology, UT Southwestern

High blood pressure, also known as hypertension, is the leading preventable risk factor worldwide for a bevy of conditions including cardiovascular disease, chronic kidney disease, stroke, and dementia, as well as for death from any cause. Although the prevalence of hypertension has decreased in high-income countries over the past several decades, it has increased in low- and middle-income countries.

Uncontrolled hypertension is a major public health challenge worldwide. Only 22.5% of patients with hypertension in the U.S. have their blood pressure controlled. More concerning, this figure drops to 13.6% in low- and middle-income countries.

Current U.S. and global guidelines recommend single-pill combination therapy as the preferred treatment strategy. This approach lowered blood pressure more and faster than multi-pill regimens in several clinical trials while offering additional benefits, including the convenience of taking just one pill and fewer side effects. However, Dr. He explained, most of these trials lasted only a few weeks, leaving it unclear whether this strategy can control hypertension over the long term.

To answer this question, Dr. He co-led the Caribbean and South American Team-Based Strategy to Control Hypertension (CATCH) randomized clinical trial with colleagues in Colombia, Jamaica, and the U.S. The trial lasted four years, including recruitment of 1,706 patients with uncontrolled hypertension who were treated at 40 primary care clinics in Colombia and Jamaica.

In half of the clinics, patients received the standard care to treat this condition, mainly a strategy known as "stepped care." In this model, patients start on a single antihypertensive drug, with physicians increasing dosages and adding more drugs over time if hypertension remains uncontrolled.

In the other half, patients took a polypill that combined two or three antihypertensive medications. In addition, nurses taught these patients how to measure blood pressure at home with study-supplied equipment and regularly reviewed their results. A health coach also trained them on improving medication adherence.

After 18 months, results showed that taking the single-pill combination lowered patients' systolic blood pressure (the top number in a standard blood pressure reading) by an average of about 19 points, while those receiving usual care only had a 9-point decrease. Nearly 70% of the single-pill group reached the trial's goal of systolic blood pressure below 130 mm Hg and diastolic blood pressure (the lower number in a standard blood pressure reading) below 80 mm Hg; only 29% of the standard care group met this benchmark.

Six months after the trial ended, 75% of patients in the intervention group were still receiving single-pill combination treatment covered by their health insurance or government programs and maintained better blood pressure control, suggesting that the single-pill combination strategy is sustainable.

Only about 10% of patients with hypertension are treated with single-pill combination therapy in the U.S., Dr. He said. Physician surveys suggest this divergence from guidelines stems from unfamiliarity with this treatment option as well as a lack of evidence from large, long-term clinical trials. While the CATCH trial partially fills this gap, he added, more large clinical trials evaluating the effects of single-pill combination therapy on clinical outcomes are urgently needed to persuade physicians and patients to widely adopt this approach for hypertension control.

Other UTSW authors who contributed to this study are co-first author Jing Chen, M.D., M.Sc., Professor of Internal Medicine in the Division of Nephrology, the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, and of Epidemiology; Song Zhang, Ph.D., Professor of Epidemiology; Paola Lanza, M.D., Population Science Project Coordinator; and Siyi Geng, M.S., and Haowen Qin, M.S.P.H., Biostatistical Consultants.

The study was funded by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (UG3/UH3 HL152373).

Dr. He holds the S. Roger and Carolyn P. Horchow Chair in Cardiac Research, in Honor of Jere H. Mitchell, M.D.