What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=2736). Intervention: Single-pill combination (SPC) therapy vs. Equivalent multi-pill therapy. Primary outcome: Achieving target blood pressure by 6 months (OR 1.22, 95% CI 1.05, 1.42).

What does this research mean for the field?

Single-pill combination therapy is associated with a 22% increased likelihood of achieving target blood pressure by 6 months compared to equivalent multi-pill therapy, resulting in more rapid and sustained blood pressure reduction without increasing serious adverse events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aimed to evaluate the effectiveness of single-pill combinations for blood pressure control in hypertensive patients.

May 9, 2026Open Access

5 Association between single-pill combination therapy use and blood pressure control in the systolic blood pressure intervention trial (SPRINT): A post hoc analysis

Key Result

Single-pill combination therapy was associated with a 22% increased likelihood of achieving target blood pressure by 6 months compared to equivalent multi-pill therapy (OR 1.22).

Key Points

This analysis aimed to evaluate the effectiveness of single-pill combinations for blood pressure control in hypertensive patients.
Post hoc analysis of SPRINT involving 2,736 participants propensity matched 1:2.
Assessment of blood pressure change using generalized linear mixed models with SPC*time interactions.
Multivariable Cox models evaluated SPC use with cardiovascular events and serious adverse events.
SPC use increased the likelihood of achieving target blood pressure by 6 months (OR: 1.22, 95% CI: 1.05, 1.42).
Participants on SPC experienced a greater monthly blood pressure reduction (-2.0 mmHg vs. -1.2 mmHg; p-diff<0.001).
No significant difference in serious adverse events between SPC and multi-pill therapy groups.

Study Design

Type

Observational (n=2,736)

Multicenter

Yes

Structured PICO

Does single-pill combination therapy improve blood pressure control in patients with hypertension compared to equivalent multi-pill therapy?

Population

2,736 participants from the SPRINT trial (US patients with hypertension), propensity matched in a 1:2 ratio.

Intervention

Single-pill combination (SPC) therapy

Comparator

Equivalent multi-pill therapy

Outcome

Achieving target blood pressure by 6 monthssurrogate

Single-pill combination therapy is associated with more rapid and sustained blood pressure reduction and a greater likelihood of achieving target BP compared to equivalent multi-pill therapy.

Main Result

Effect estimate: OR 1.22 (95% CI 1.05, 1.42)

Abstract

Objectives/Goals: Blood pressure (BP) control remains suboptimal among US patients with hypertension. Single-pill combination (SPC) therapies are commonly used to improve adherence; however, their effectiveness for achieving early and sustained intensive BP control is unclear. Methods/Study Population: We performed a post hoc analysis of SPRINT including 2,736 participants propensity matched in 1:2 ratio to compare effects of SPCs with equivalent multi-pill therapy. The estimated marginal odds of achieving optimal BP control were derived using generalized linear mixed models with repeated measures (LMMRM). The association between time-updated SPC use and BP change in short- (≤6 months) and long-term (>6 months) follow-up was assessed with LMMRM and SPC*time interaction term. Multivariable Cox models evaluated association of SPC use with CV events and serious adverse events (SAEs). Results/Anticipated Results: Among SPRINT participants (N=8623), 9.3% (N=803) were prescribed SPC at baseline with greater use in the intensive vs. usual care group (5.79 vs. 3.90 per 100 person-months; p-diff<0.001). Among matched pairs (SPCn=912); multi-pill therapy[n=1824), SPC use was associated with 22% increased likelihood of achieving target BP by 6 months OR(95% CI): 1.22(1.05, 1.42). Participants receiving SPCs (vs multi-pills) experienced more rapid BP reduction in the first 6 months (-2.0 vs. -1.2 mmHg monthly change; p-diff<0.001). Over long-term follow-up, participants using SPCs achieved significantly lower SBP at each timepoint. The risk of the primary CV composite endpoint and SAEs was not significantly different between groups. Discussion/Significance of Impact: SPC therapy resulted in more rapid and sustained BP reduction and a greater likelihood of achieving BP control compared with multi-pill therapy without increase in SAEs. Future research is needed to identify optimal strategies for implementing SPC-based approaches at the population-level and optimize public health benefits of intensive BP control.

Bookmark

View Full Paper