Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions.

Hypertension is the most prevalent cardiovascular risk factor and carries the greatest population attributable risk for cardiovascular disease [1]. Better hypertension control is among the most effective public health and population healthcare levers for reducing years of life lost and disability adjusted life years [2]. Unfortunately, the global burden of hypertension and related cardiovascular and renal diseases continues to grow. Hypertension control rates remain low globally [3]. One relatively simple and potentially scalable approach to improving hypertension control is greater use of singlepill combinations (SPC) containing two or more different classes of antihypertensive medications as initial and add-in therapy [4–12]. In this editorial, the literature is selectively reviewed and summarised on SPC, especially as initial therapy, compared with monotherapy and multiple pill regimens on adherence, hypertension control, clinical outcomes, population impact and adverse effects. An attempt is made to quantify the relative use of SPC versus monotherapy and free-dose combinations in hypertension management. Barriers and potential pathways to greater use of SPC in managing hypertension are explored.