skip to main content

Single-pill Combinations — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHypertension & Preventive CardiologySingle-pill CombinationsEECC

A 60-year-old man with hypertension on ramipril 10 mg and amlodipine 10 mg has a clinic BP of 152/94 mmHg. The 2024 ESC Hypertension Guidelines recommend single-pill combinations (SPC) as first-line. What is the rationale?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — SPCs improve adherence compared with free-drug combinations, and the majority of hypertensive patients require ≥2 agents to achieve target BP

The 2024 ESC Hypertension Guidelines strongly recommend initial therapy with a two-drug single-pill combination (SPC) for most hypertensive patients (Class I, LOE B). The rationale: (1) most patients (60-70%) need ≥2 drugs to achieve BP targets; (2) SPCs significantly improve adherence — reducing pill burden is the single most effective strategy to improve adherence (demonstrated in multiple studies including the UMPIRE trial); (3) earlier achievement of BP control reduces cardiovascular events. Recommended first-line SPCs: ACEi/ARB + CCB, or ACEi/ARB + thiazide/thiazide-like diuretic. Step 2: triple SPC (ACEi/ARB + CCB + thiazide). Beta-blockers are explicitly positioned as third-line.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension