Single-Pill Blood Pressure Therapy Outperforms Multi-Pill Care Over Four-Year Trial in Colombia and Jamaica

At 40 primary care clinics across Colombia and Jamaica, 1,706 patients with uncontrolled high blood pressure were enrolled in a trial that ran for four years. Its question was simple: if you give people one pill that contains two or three blood pressure drugs, does their pressure stay down over the long haul better than it does under ordinary care?

The trial is called CATCH, short for the Caribbean and South American Team-Based Strategy to Control Hypertension. It was co-led by Dr. Jiang He of UT Southwestern Medical Center, who chairs epidemiology at the Peter O'Donnell Jr. School of Public Health, together with colleagues in Colombia, Jamaica, and the United States. Results were presented in a Late-Breaking Science session at the 2026 American Heart Association Scientific Sessions and published at the same time in JAMA.

The clinics were split in half. In one group, patients received standard care, mostly a approach called stepped care: start with a single drug, then raise the dose or add more medications over time if pressure stays high. In the other group, patients took a polypill combining two or three antihypertensive drugs. Those patients also got extra support. Nurses taught them to measure blood pressure at home, using equipment supplied by the study, and reviewed their readings regularly. A health coach trained them on taking their medication consistently.

After 18 months, systolic pressure, the top number, had fallen by an average of about 19 points in the single-pill group. In the usual-care group the drop was 9 points. Nearly 70% of single-pill patients reached the trial's target of below 130 systolic and below 80 diastolic. Among those receiving standard care, 29% did.

The results also held up after the study ended. Six months later, 75% of patients in the intervention group were still on single-pill treatment paid for by their health insurance or government programs, and they kept better blood pressure control. Dr. He took that as a sign the strategy is sustainable.

The stakes are large. Hypertension is the leading preventable risk factor worldwide for cardiovascular disease, chronic kidney disease, stroke, dementia, and death from any cause. Its prevalence has fallen in high-income countries over recent decades but risen in low- and middle-income ones. Control is poor everywhere: only 22.5% of U.S. patients with hypertension have their pressure controlled, and the figure is 13.6% in low- and middle-income countries.

U.S. and global guidelines already name single-pill combination therapy as the preferred approach. Earlier trials found it lowered pressure more and faster than multi-pill regimens, with the convenience of one pill and fewer side effects. But Dr. He noted that most of those trials lasted only weeks, leaving the long-term question open. CATCH addresses it. He described the approach as effective, implementable, scalable, and sustainable in low- and middle-income countries, one that improves adherence and patient satisfaction with medication and care, and he said the trial gives U.S. physicians more evidence to recommend it.

Practice still lags the guidelines. Only about 10% of U.S. patients with hypertension receive single-pill combination therapy, Dr. He said. Physician surveys point to unfamiliarity with the option and a shortage of large, long-term trial evidence. CATCH partly fills that gap, he said, but larger trials measuring clinical outcomes are urgently needed to persuade physicians and patients to adopt it widely.

Other UT Southwestern authors include co-first author Jing Chen, Song Zhang, Paola Lanza, Siyi Geng, and Haowen Qin. The National Heart, Lung, and Blood Institute funded the study.