Combination blood pressure medications
At the European Society of Cardiology (ESC) congress at the end of August 2018 in Munich, the new guideline on drug treatment for high blood pressure was presented.
Until now, people with high blood pressure were usually prescribed medication made up of one or several separate single-agent drugs. The new guideline now recommends combination medicines as the standard therapy; these combine two or three active ingredients in one pill.
These offer many advantages:
- fewer pills to take
- lower doses of each active ingredient
- better blood pressure control
- fewer side effects
- improved adherence (patients more likely to take their medicines as prescribed)
Using combination medicines is expected to improve the situation in several ways. First and foremost, taking the medication becomes easier for the patient when they only have to take one tablet instead of two or three different ones. That single tablet then already contains the active ingredients of the two or three previously taken drugs, or can replace them through a suitable combination. In addition, combination products often use lower amounts of each active ingredient, which reduces the risk of side effects. This should also increase adherence and reduce the occurrence of secondary diseases.
A study published in April 2023 showed that combination pills can also be an alternative treatment for people with newly or relatively newly diagnosed high blood pressure.
A study published in April 2023 showed that combination pills can also be an alternative treatment for people with newly or relatively newly diagnosed high blood pressure.
Adherence (as has been observed) steadily decreases as the number of pills to take increases. The more pills someone is supposed to take, the less willing they often are to do so. The risk of forgetting a medication, or of making mistakes when putting together the "doses" of pills to be taken, also increases the more items are listed on the medication schedule.
If blood pressure medicines are not taken as prescribed, this can have serious consequences. Heart attack, stroke and sudden cardiac death are the most severe outcomes that can result from an incomplete or ignored treatment plan. High blood pressure can also damage many other parts of the body for example the kidneys or the eyes. In addition to reduced quality of life, these secondary diseases also cause high treatment costs.
If blood pressure medicines are not taken as prescribed, this can have serious consequences. Heart attack, stroke and sudden cardiac death are the most severe outcomes that can result from an incomplete or ignored treatment plan. High blood pressure can also damage many other parts of the body for example the kidneys or the eyes. In addition to reduced quality of life, these secondary diseases also cause high treatment costs.
A study from Nigeria published in August 2024 also showed a better reduction in blood pressure among participants taking a 3-in-1 preparation compared with treatment with individual active ingredients. Blood pressure fell faster and by a greater amount with the combination pill.
At the ESC Congress 2024 a study was presented that examined the effect of a four-drug combination in patients who had not achieved adequate blood pressure lowering with a three-drug pill. It showed improved blood pressure reduction in the group that received an additional active ingredient. In that group, blood pressure fell to below 140/90 mmHg in over 66% of participants. In the comparison group, which continued taking the 3-in-1 combination, this was achieved in only 42%. The researchers thus demonstrated the superiority of a four-drug single tablet for people with therapy-resistant or difficult-to-control high blood pressure.
Although this guideline change initially raises costs for health insurers, since combination products are usually more expensive than single-agent drugs, the high costs for treating secondary diseases are reduced in the long run.
A study published in Clinical Research in Cardiology examined the prescription frequency of combination products between 2016 and 2020. It concluded that, despite the 2018 guideline adjustments, combination products still make up only a small share of prescribed hypertension medications.
Source:
- https://www.hochdruckliga.de/nachricht/neue-europaeische-leitlinie-empfiehlt-kombipraeparate-zur-blutdrucksenkung
- https://www.apotheke-adhoc.de/nachrichten/detail/pharmazie/dreifach-blutdrucksenker-halbe-dosis-bessere-wirkung-hypertonie/
- https://link.springer.com/article/10.1007/s00392-022-01993-5
- https://www.aerzteblatt.de/nachrichten/133348/Bluthochdruckbehandlung-in-Deutschland-entspricht-laut-Fachgesellschaft-selten-Leitlinienstandards
- https://jamanetwork.com/journals/jamacardiology/fullarticle/2804313
- https://jamanetwork.com/journals/jama/fullarticle/2823291
- https://www.escardio.org/The-ESC/Press-Office/Press-releases/A-single-tablet-with-4-blood-pressure-lowering-drugs-can-be-more-effective-than-taking-3-drugs-in-separate-pills
This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based information and is continuously updated (as of 12/2025).
Author Dr. Christine Berchtold-Benchieb is a specialist in general medicine, studied at LMU Munich, and has worked in hospitals as well as in several general and specialist practices. Her many years of daily care for patients with high blood pressure combine evidence-based expertise with practical experience, ensuring reliable recommendations.
Author Dr. Christine Berchtold-Benchieb is a specialist in general medicine, studied at LMU Munich, and has worked in hospitals as well as in several general and specialist practices. Her many years of daily care for patients with high blood pressure combine evidence-based expertise with practical experience, ensuring reliable recommendations.
We hope you found the article helpful. For good blood pressure control, it's important to take your medications correctly. Our app BloodPressureDB will gladly remind you when to take them.
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