Single Pill Combinations for Blood Pressure

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Poor control of blood pressure (BP) is bad news, and is associated with enhanced risk of cardiovascular disease. Therapy with a single blood pressure medication fails to reach goals 75% of the time. This is just one reason that single pill combinations (two different blood pressure medications in one pill) make perfect sense.

Combining medications that have different and often complementary actions can lead to more complete and prompt reductions in BP. Side effects may also be better as certain classes of high blood pressure medications reduce adverse effects associated with, other medications. Of course one pill is easier than two, so single pill combinations also provide for better patient compliance.

What are the most popular single pill combinations for blood pressure control?

1. Calcium channel blocker + angiotensin converting enzyme inhibitor (ACE inhibitor) combinations like amlodipine/benazepril (Lotrel), work well and are associated with fewer adverse effects and better outcomes than either med alone. Amlodipine also comes paired with an angiotensin receptor blocker (ARB) in two brand name drugs: Exforge (amlodipine/valsartan) and Twynsta (amlodipine/telmisartan). The main side effect of amlodipine, swelling in the legs, is eliminated with the combination pill.

2. ACE Inhibitor + hydrochlorothiazide (HCTZ) combinations offer tons of choices and all are generic which is great. Benazepril/hctz, lisinopril/hctz, enalapril/hctz and other combinations have been shown to be more effective than the two separately with better side effects (they cancel out problems with potassium).

3. Angiotensin receptor blocker (ARB) + HCTZ single pill combinations. Take advantage here of some of the newer generics in this class of excellent blood pressure medications. Avalide (irbesartan/hctz), Diovan HCT (valsartan/hctz) and Hyzaar (losartan/hctz) are all available in generic form. Again, these single pill combos not only make adherence easier but work together better than they do alone.

4. There are also some beta blocker + diuretic combinations like atenolol/chlorthalidone and metoprolol/hctz.

If you are taking more than one pill for your blood pressure, get to know these combinations. Combination antihypertensive therapy, especially with the single pill formulations just discussed, can more effectively control blood pressure and improve side effects and compliance while lowering costs.

It’s a no brainer.

Dr O.

Many generic combination blood pressure medications, such as lisinopril/hctz, benazepril/hctz, and atenolol/chlorthalidone are available for cash prices as low as $4 – $5 per month through some pharmacies’ discount generic programs. Others such as amlodipine/benazepril and metoprolol/hctz can cost a bit more, around $15 – $30 per month without insurance. All of the above blood pressure generics should be covered under most insurance plans as Tier 1 drugs, meaning you’ll pay only your lowest copay.

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