Abstract
Background: Use of single pill combination (SPC) antihypertensive medications is associated with improved medication adherence and blood pressure (BP) outcomes compared with combinations of the same medications and doses taken as separate pills. We analyzed time trends of SPC use and BP control among US adults taking multiple antihypertensive medications and identified factors associated with SPC use. Methods: Combining National Health and Nutrition Examination Survey (NHANES) data from 2009-2018, we included participants aged >=20 years with hypertension and taking >=2 antihypertensive medications. Number of antihypertensive medications and SPC use were identified from self-reported prescription medications. Controlled BP was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. The age-adjusted proportion of individuals using SPC medications and BP control were estimated across each NHANES cycle. Multivariable logistic regression was used to assess trends in SPC use, BP control, and factors associated with SPC use. All estimates accounted for the complex survey design and represented the US population. Findings: Overall, 5,365 NHANES participants were included; mean (SD) age was 63.9 (12.0) years and 53.0% were female. SPC antihypertensive medication use decreased from 38.2% in 2009-2010 to 28.8% in 2017-2018 ( Figure , p=0.01). Similarly, BP control decreased from 72.1% in 2009-2010 to 64.4% in 2017-2018 (p=0.01). Age, male sex, body mass index, concurrent use of lipid-lowering therapy, and history of cardiovascular disease were significantly associated with decreased odds of SPC use. Conclusions: In the last decade, use of SPC antihypertensive medications and BP control each have decreased significantly among US adults taking >=2 antihypertensive medications. Randomized trial evidence supports SPCs over separate pill combinations to improve BP outcomes. Efforts should be made to increase SPC use in targeted populations (e.g., those with comorbidities or polypharmacy).
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