Page 5 - hypertension_newsletter

REFLECTIONS
Hypertension
Hypertension Global Newsletter #10 2026

The statement emphasizes that the clinical and economic benefits of SPCs far outweigh their limitations. Clinical data demonstrate
that initiating treatment with a two-drug SPC yields faster, more sustained BP control and better long-term medication adherence
than the traditional stepped-care approach. For example, combining two agents with complementary mechanisms results in about
Hypertension
five times larger reduction in BP compared with doubling the dose of a single drug. The committee highlights that combination
regimens should ideally pair a renin-angiotensin
system inhibitor, such as an ACEi or an ARB, with Benefits versus limitations of SPCs
a CCB or a thiazide diuretic. Notably, data from in the management of hypertension
the ACCOMPLISH trial demonstrated that an
SPC combining an ACEi (benazepril) and a CCB
(amlodipine) was 20% more effective at preventing
major CV events compared to combining an ACEi
with a diuretic.

Despite their proven clinical value, the uptake of SPCs
remains low; approximately 40% of US adults with
uncontrolled hypertension still rely on monotherapy.
The authors identify several barriers driving this
underutilization. Clinicians often hesitate to prescribe
SPCs due to a perceived lack of dosing flexibility if
adverse events occur. Simultaneously, patients face
structural barriers such as high out-of-pocket costs,
restrictive insurance formularies (like Medicaid and
Medicare Part D favoring separate generic pills), and
the lack of commercially available triple- or quadruple-
drug SPCs. In the United States, only two triple SPCs
are widely available, and no quadruple products
have been approved. More triple and quadruple SPC
options are needed to address the considerable
proportion of patients requiring ≥3 antihypertensive
agents. These access gaps disproportionately affect
lower-income and under-resourced communities,
exacerbating existing racial and socioeconomic
disparities in CV health.

The AHA concludes that making SPC therapy the standard,
first-line approach for most hypertensive patients is a
necessary and highly effective strategy to overcome clinical
inertia, improve long-term patient adherence, and significantly
reduce the global burden of CVD.
CLICK HERE
WATCH AUTHORS JORDAN B. KING
(WRITING GROUP CHAIR) AND
ROBERT D. BROOK (VICE CHAIR)
DISCUSS THE POTENTIAL BENEFITS
OF USING SINGLE-PILL COMBINATION
CLICK HERE THERAPY FOR MANAGING HIGH
FOR THE LINK TO FULL ARTICLE BLOOD PRESSURE (4:30)

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