Single-pill combinations of antihypertensive drugs lowered systolic blood pressure by 19 points over 18 months in a four-year trial across Colombia and Jamaica, more than double the 9-point drop from standard stepped care, News-Medical reported.
The CATCH trial enrolled 1,706 patients with uncontrolled hypertension at 40 primary care clinics, splitting them between usual stepped care and a polypill containing two or three medications paired with home monitoring and adherence coaching.
“Our study demonstrated that a single-pill combination provided an effective, implementable, scalable, and sustainable approach for hypertension control in low- and middle-income countries,” said Jiang He, epidemiologist at UT Southwestern Medical Center, which co-led the research.
In the standard-care group, physicians started patients on one drug and added more over time if blood pressure stayed high. In the intervention group, patients took a single pill combining two or three antihypertensives, while nurses taught them to measure blood pressure at home and a health coach reinforced medication adherence.
After 18 months, the single-pill group saw systolic pressure—the top number in a reading—fall by an average of about 19 mm Hg, compared with a 9 mm Hg decrease in the usual-care group.
| Outcome at 18 Months | Single-Pill Combination | Standard Stepped Care |
|---|---|---|
| Average systolic reduction | 19 mm Hg | 9 mm Hg |
| Reached target below 130/80 mm Hg | Nearly 70% | 29% |
Six months after the study ended, 75% of patients in the single-pill group were still receiving the combination treatment through insurance or government programs and maintained better blood pressure control, suggesting the approach is sustainable in resource-constrained settings.
The findings, published in JAMA and presented at the 2026 American Heart Association Scientific Sessions, address a gap left by earlier trials that lasted only a few weeks.
Current U.S. and global guidelines recommend single-pill combination therapy as the preferred strategy, yet only about 10% of American patients with hypertension receive it, Dr. He said. Physician surveys suggest unfamiliarity and a lack of long-term evidence drive this divergence.
Hypertension remains the leading preventable risk factor worldwide for cardiovascular disease, stroke, and death. Only 22.5% of U.S. patients have their blood pressure controlled, and the figure drops to 13.6% in low- and middle-income countries.
While the CATCH trial demonstrates long-term effectiveness, Dr. He noted that more large clinical trials evaluating single-pill combinations against hard clinical outcomes—such as heart attacks and strokes—are urgently needed to persuade physicians and patients to adopt the strategy widely.
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