I have written this many times before, but policies and protocols in medicine are always changing. After several years of treating a disorder one way, another idea surfaces that changes the whole landscape. One such example is what has happened in the treatment of high blood pressure.
After decades of what was known as the “step-care approach,” a new treatment regimen using a single-pill combination medication has become the method of choice. “Step-care” involved the prescribing of one drug at a time and gradually increasing its dose until the BP was controlled, the maximum dose was reached, or side effects made it unusable. If the BP was not lowered to the target level, a second drug was added to the first. Again, the dose of the second drug was increased as with the first. If control was still not achieved a third, fourth, and even fifth drug was added.
The new approach uses combination drugs meaning two, and sometimes three, drugs are combined into a single pill. Multiple dosage strengths of the same combination are available so it’s a bit of a guessing game where to start dosage-wise, but once the right dose is reached, all goes smoothly. This approach allows for quicker, more consistent control of BP, improves long-term patient adherence, and makes treatment easier. Patients like this approach because they’re burdened only by taking a single pill rather than 2, 3, or 4. It is also convenient and cost efffective to refill only one medication rather multiple prescriptions.
The experts at the American Heart Association and the American College of Cardiology also claim this approach reduces the risk of heart attack and stroke, but for 75+ years, doctors have known BP control is essential to preventing strokes, heart attacks, heart failure, and chronic kidney disease. That’s not new information. But whether the new combination pill approach is better at reducing risk is not known, yet. But the goal is to lower BP, and it’s that that reduces risk.
Dr. G’s Opinion: I had a personal bias against combination drugs. Choosing the right dosage combination was a guess, and I worried about causing side effects or lowering the BP too much. I always prescribed one drug at a time, maxed out the dose, then added another if necessary. When I reached the dosage combination that controlled the BP, I would prescribe the combination medication that contained the dosages of the drugs I was using. That worked fine. Then the patient’s BP wasn’t up and down all over the place.
Reference: Kelly M. Single-pill Approach Proves Beneficial in Hypertension Medscape 2025 December 23.
