What does this research mean for the field?

Fixed-dose combination antihypertensive therapy is associated with significantly lower emergency department visits, hospitalizations, office-based visits, and prescription fills compared to multi-pill combination therapy in U.S. adults with hypertension. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to compare the healthcare utilization of U.S. adults with hypertension treated with fixed-dose combination therapy versus multi-pill combination therapy.

March 8, 2026Open Access

Fixed-dose combination antihypertensive therapy and healthcare utilization in U.S. adults with hypertension: a propensity score–based analysis of a nationally representative population

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: U.S. adults aged ≥18 years with diagnosed hypertension on combination antihypertensive therapy of ≥2 drug classes (n=18269). Intervention: Fixed-dose combination (FDC) antihypertensive therapy vs. Multi-pill combination (MPC) antihypertensive therapy. Primary outcome: Annual healthcare utilization including office-based visits, outpatient visits, emergency department visits, hospitalizations, and prescription fills (RR 0.712 for emergency department visits, RR 0.721 for hospitalizations, RR 0.934 for office-based visits, RR 0.853 for prescription fills, 95% CI 95% CI 0.636–0.796 for ED visits, 0.545–0.953 for hospitalizations, 0.879–0.993 for office visits, 0.815–0.893 for prescription fills, p=<0.0001 for ED visits and prescription fills, 0.0219 for hospitalizations, 0.0281 for office visits).

Key Result

Fixed-dose combination antihypertensive therapy was associated with 29% fewer hospitalizations (RR 0.721) and 29% fewer emergency department visits (RR 0.712) compared to multi-pill therapy in US adults with hypertension on combination treatment.

Key Points

This research aims to compare the healthcare utilization of U.S. adults with hypertension treated with fixed-dose combination therapy versus multi-pill combination therapy.
Conducted a cross-sectional study using Medical Expenditure Panel Survey data from 2013-2022.
Included adults aged ≥18 years with hypertension on ≥2 antihypertensive classes.
Applied inverse probability of treatment weighting to balance covariates.
Used weighted negative binomial regression to assess healthcare utilization impacts.
Performed a 1:1 propensity score matching analysis for robustness.
Among 18,269 adults, 5,849 used fixed-dose combination therapy and 12,420 used multi-pill combination therapy.
FDC users had significantly lower emergency department visits (RR = 0.712; p < 0.0001).
FDC users experienced fewer hospitalizations (RR = 0.721; p = 0.0219).
Office-based visits were also lower for FDC users (RR = 0.934; p = 0.0281).
Prescription fills were reduced in FDC users (RR = 0.853; p < 0.0001).

Study Design

Type

Cross-Sectional (n=18,269)

Multicenter

Yes

Structured PICO

Does fixed-dose combination antihypertensive therapy reduce healthcare utilization in adults with hypertension compared to multi-pill combination therapy?

Population

18,269 US adults (aged ≥18 years) with diagnosed hypertension receiving ≥2 antihypertensive classes, mean age 66, 51% male.

Intervention

Fixed-dose combination (FDC) antihypertensive therapy (single-pill product containing ≥2 antihypertensive drug classes)

Comparator

Multi-pill combination (MPC) antihypertensive therapy (≥2 antihypertensive drug classes dispensed as separate pills)

Outcome

Healthcare utilization, including office-based visits, hospital outpatient visits, emergency department visits, prescription fills, and inpatient hospitalizations measured as annual counts within the same survey year

Fixed-dose combination antihypertensive therapy is associated with significantly lower acute healthcare utilization and prescription burden compared to multi-pill regimens in US adults.

Main Result

Effect estimate: RR 0.712 for emergency department visits, RR 0.721 for hospitalizations, RR 0.934 for office-based visits, RR 0.853 for prescription fills (95% CI 95% CI 0.636–0.796 for ED visits, 0.545–0.953 for hospitalizations, 0.879–0.993 for office visits, 0.815–0.893 for prescription fills)

p-value: p=<0.0001 for ED visits and prescription fills, 0.0219 for hospitalizations, 0.0281 for office visits

Limitations

Cross-sectional design limits causal inference due to simultaneous measurement of exposure and outcomes
Reliance on prescription fills may not reflect true medication adherence
Residual confounding possible due to unmeasured factors such as blood pressure level and hypertension severity
No direct clinical data on blood pressure or cardiovascular events in dataset
Exposure classification did not account for drug class or dosage variations
Potential misclassification due to treatment switching within the year
Possible recall bias and underreporting inherent in survey data

Abstract

Background Fixed-dose combination (FDC) antihypertensive therapy is recommended by contemporary guidelines to improve adherence and blood pressure control. However, real-world evidence evaluating its impact on healthcare utilization, compared with the multi-pill combination (MPC) therapy in hypertension (HTN) patients, remains limited. This study compared healthcare utilization among US adults with HTN receiving FDC versus MPC therapy. Methods We conducted a cross-sectional study on nationally representative data from the Medical Expenditure Panel Survey (2013-2022). Adults aged ≥18 years with a diagnosed HTN on ≥2 antihypertensive classes were classified as FDC or MPC users. Inverse probability of treatment weighting was applied to balance covariates. Weighted negative binomial regression models were used to assess the impact of FDC versus MPC on healthcare utilization, including office-based visits, outpatient visits, emergency department visits, hospitalizations, and prescription fills. A 1:1 propensity score matching (PSM) analysis was conducted as a sensitivity analysis to assess findings robustness. Results Among 18,269 adults receiving ≥2 antihypertensive therapies, 5,849 were FDC users, and 12,420 were MPC users. Compared with MPC users, FDC users had significantly lower emergency department visits (rate ratio RR = 0.712; 95% confidence interval CI: 0.636–0.796; p 0.0001), hospitalizations (RR = 0.721; 95% CI: 0.545–0.953; p = 0.0219), office-based visits (RR = 0.934; 95% CI: 0.879–0.993; p 0.0281), and prescription fills (RR = 0.853; 95% CI: 0.815–0.893; p 0.0001). No significant difference was observed in the outpatient visit rate. Findings were consistent in PSM analysis. Conclusion FDC antihypertensive therapy was associated with significantly lower acute care utilization and prescription burden while preserving routine outpatient care, compared with the MPC therapy. These findings support FDC therapy use as a high-value strategy to enhance real-world HTN management and reduce acute healthcare utilization.

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Cite This Study

Eissa A. Jafari (Fri,) conducted a cross-sectional in U.S. adults aged ≥18 years with diagnosed hypertension on combination antihypertensive therapy of ≥2 drug classes (n=18,269). Fixed-dose combination (FDC) antihypertensive therapy vs. Multi-pill combination (MPC) antihypertensive therapy was evaluated on Annual healthcare utilization including office-based visits, outpatient visits, emergency department visits, hospitalizations, and prescription fills (RR 0.712 for emergency department visits, RR 0.721 for hospitalizations, RR 0.934 for office-based visits, RR 0.853 for prescription fills, 95% CI 95% CI 0.636–0.796 for ED visits, 0.545–0.953 for hospitalizations, 0.879–0.993 for office visits, 0.815–0.893 for prescription fills, p=<0.0001 for ED visits and prescription fills, 0.0219 for hospitalizations, 0.0281 for office visits). Fixed-dose combination antihypertensive therapy was associated with 29% fewer hospitalizations (RR 0.721) and 29% fewer emergency department visits (RR 0.712) compared to multi-pill therapy in US adults with hypertension on combination treatment.

synapsesocial.com/papers/69ada873bc08abd80d5bb5b1 https://doi.org/https://doi.org/10.3389/fphar.2026.1787754

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