Media release

From: George Institute for Global Health

Treating high blood pressure with single pill combinations saves lives and money

A new Australian study published in the latest issue of Journal of Hypertension shows that treating hypertension first-line with single pills combining two or more medications provides effective control and also delivers substantial cost savings to both consumers and payers, when compared with equivalent doses in multiple pills.¹

The study, led by The George Institute for Global Health with support from Lund University, analysed 57 single-pill combinations (SPCs) listed on the Pharmaceutical Benefits Scheme (PBS) and found SPCs cost less for patients in nearly all cases, with average savings of 30% for general patients (before reaching the PBS safety net in a given year).¹ Government savings were also significant, especially for Concession Card holders, with cost reductions of up to 26% compared with equivalent free-drug combinations.¹

International guidelines recommend SPCs as the first step in treating hypertension, as they have been shown to improve medication adherence, combat treatment inertia, improve blood pressure control and reduce cardiovascular events.² Evidence shows that most patients require more than one medication to manage the condition.³

Despite this, PBS restrictions currently prevent SPCs from being prescribed as initial therapy even though most are widely available in affordable generic form.

One in three (34% or around 6.8 million) Australian adults have hypertension but 50% are unaware they have it, and only 32% of those treated have their blood pressure controlled to a healthy range - well behind countries such as Canada (68%).⁴ Hypertension persists as the leading risk factor for death in Australia.⁵ It is linked to serious cardiovascular conditions, cognitive decline, kidney disease and pregnancy complications. A 25% reduction in prevalence could save around 37,000 lives annually.⁶

While steps are being taken to update Australia’s clinical treatment guidelines,⁷ the new study demonstrates a need to update Australia’s PBS criteria to realise the patient outcomes and economic benefits of SPCs as first-line therapy for hypertension.⁸

“This research confirms what international guidelines have long recommended,” said Professor Alta Schutte, co-author of the study and Co-Director of the Global Cardiovascular Program at The George Institute, and Professor of Cardiac, Vascular and Metabolic Medicine at UNSW Sydney. “Starting treatment with single-pill combinations is safer, more effective, and more economical than multiple pills of equivalent dose. Updating Australia’s clinical guidelines is an important step, but reimbursement criteria must also be changed to enable clinicians to follow global best practice.

“Currently, Australia’s PBS rules make it difficult for doctors to start patients on single-pill combinations, despite clear evidence that they reduce serious risks like heart attacks and strokes. Our analysis shows that using these combinations could save money for both patients and the government. This is a real opportunity to improve policy, cut costs, and most importantly, save lives,” she said.

High out-of-pocket expenses are a major barrier to proper treatment and long-term medication use. In 2022, Australia spent $1.2 billion managing hypertension, with patients covering 41% of those costs out of pocket. In December 2024, the Pharmaceutical Benefits Advisory Committee recommended making all dual therapy fixed dose combination (FDCs) for hypertension available as unrestricted benefits, highlighting the likely cost savings for the PBS and consumers.⁸

Removing the current restriction on first-line FDC prescribing will also be essential to ensuring Australian practice aligns with evidence and international best practice.

The Heart Foundation and Stroke Foundation, in collaboration with Hypertension Australia, are in the process of updating the Australian Hypertension Guidelines.⁷ Currently all major international hypertension guidelines, including the most recent 2024 European Society of Cardiology guidelines, recommend starting with a dual SPC and progressing to a triple SPC when necessary.¹

Updating the guidelines will go some way towards addressing the major challenge of ‘treatment inertia’ in general practice – where doctors may delay increasing medication or changing therapy even when blood pressure remains high. Only 10% of visits for uncontrolled hypertension result in treatment intensification,⁹ and a 2018 study found that 39% of Australian hypertension patients aged 45-74 had not been prescribed medication in the past six months, including 40% of those at moderate-to-high cardiovascular risk.¹⁰

The findings of this study make it clear that the government must urgently remove PBS restrictions and update drug labels to allow SPCs to be use as first-line therapy, which would:

• Improve health outcomes for millions of Australians
• Reduce out-of-pocket costs for government and consumers
• Align Australia with international treatment standards
• Support the government’s “Measuring What Matters” health priorities

“We have the tools and the data - what’s needed now is policy change,” said Prof Schutte. “The evidence in favour of SPCs as first-line treatment is overwhelming, it should be standard practice in Australia. Now is the time for the government to act by updating PBS restrictions so clinicians can follow global best practice. This would be a win-win for consumers and for the health system.”

The George Institute for Global Health

At The George Institute, we believe everyone has the right to a healthy life. With major centres in Australia, the UK and India, and over 245 active projects in more than 50 countries, we work with partners and communities across the world to conduct rigorous, high-quality research to drive meaningful improvements in health, especially for those facing the greatest barriers. From pioneering clinical trials to transformative digital health innovations, translating evidence into scalable solutions, shaping health policies and advocating for change, we’re focused on a future where health equity is a reality, not just an aspiration. At the heart of our mission to improve the health of millions worldwide is a belief in the power of change. Together, we’re building a healthier, more just world. Visit: www.georgeinstitute.org

References

1. Pikkemaat, M., E. R. Atkins, A. Rodgers, and A. E. Schutte. 2025. Treating hypertension with single pill combinations: a simple strategy to save costs for the patients and payers. Journal of Hypertension. May 2, 2025.
2. Kawalec, P., P. Holko, M. Gawin, and A. Pilc. 2018. Effectiveness of fixed-dose combination therapy in hypertension: systematic review and meta-analysis. Archives of Medical Science 14 (5): 1125–1136.
3. Nelson, M. 2010. Drug treatment of elevated blood pressure. Australian Prescriber 33 (4), August 1
4. Schutte, A. E., B. Bennett, C. K. Chow, G. C. Cloud, K. Doyle, Z. Girdis, et al. 2024. National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030. Medical Journal of Australia 221 (3), July 11.
5. Xu, X., M. Shariful, M. Schlaich, G. Jennings, and A. E. Schutte. 2024. The contribution of raised blood pressure to all-cause and cardiovascular deaths and disability-adjusted life-years (DALYs) in Australia: analysis of global burden of disease study from 1990 to 2019. PLOS ONE 19 (2): e0297229.
6. Hird, T. R., E. Zomer, A. J. Owen, D. J. Magliano, D. Liew, and Z. Ademi. 2019. Productivity burden of hypertension in Australia: a life table modelling study. Hypertension 73 (4): 777–784.
7. Heart Foundation. 2024. New guidelines for managing and treating hypertension and lipids. heartfoundation.org.au.
8. Pharmaceutical Benefits Advisory Committee. Pharmaceutical Benefits Advisory Committee (PBAC) Meeting Outcomes - December 2024 PBAC Meeting. pbs.gov.au. Accessed 20 June 2025
9. Kasanagottu, K., K. J. Mukamal, and B. E. Landon. 2024. Predictors of treatment intensification in uncontrolled hypertension. Journal of Hypertension 42 (2): 283–291
10. Usherwood, T. 2024. Therapeutic inertia. Australian Prescriber 47: 159.