What question did this study set out to answer?

To determine the effectiveness of single-pill combination (SPC) therapies in achieving blood pressure (BP) control compared to multi-pill therapies.

January 23, 2026

Association Between Single-Pill Combination Therapy Use and Blood Pressure Control in the Systolic Blood Pressure Reduction Intervention Trial (SPRINT): A Post-Hoc Analysis

Key Result

Single-pill combination therapy increased the likelihood of achieving target blood pressure control by 22% compared to multi-pill therapy in hypertension patients.

Key Points

To determine the effectiveness of single-pill combination (SPC) therapies in achieving blood pressure (BP) control compared to multi-pill therapies.
Conducted post-hoc analysis of SPRINT data with 2,736 matched participants.
Compared SPC use to multi-pill therapy in terms of BP control.
Utilized generalized linear mixed models for BP changes over time.
Applied multivariable Cox models to assess risk of cardiovascular events and serious adverse events.
9.3% of SPRINT participants were on SPC therapy, with higher usage in the intensive care group.
SPC therapy was associated with a 22% higher likelihood of reaching target BP by 6 months.
SPC users had a faster BP decline in the first 6 months compared to multi-pill users.
Throughout follow-up, SPC users maintained lower SBP levels without increased adverse events.

Structured PICO

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

Population

2,736 U.S. patients with hypertension from the SPRINT trial, propensity matched in a 1:2 ratio (SPC n=912; multi-pill therapy n=1824)

Intervention

Single-pill combination (SPC) therapy

Comparator

Equivalent multi-pill therapy

Outcome

Achieving target blood pressure control by 6 monthssurrogate

Single-pill combination therapy improves the likelihood and speed of achieving target blood pressure control compared to equivalent multi-pill therapy, without increasing adverse events.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Aims Blood pressure (BP) control remains suboptimal among U.S. 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 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 target 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 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-diff0.001). 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-diff0.001). 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 were not significantly different between groups. Conclusions SPC use resulted in greater likelihood of achieving target BP control and more rapid, sustained BP reduction without an increase in SAEs.

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