Fixed-dose combination antihypertensive therapy and healthcare utilization in U.S. adults with hypertension: a propensity score–based analysis of a nationally representative population

Background: Fixed-dose combination (FDC) antihypertensive therapy is recommended by contemporary guidelines to improve adherence and blood pressure control. However, real-world evidence evaluating its impact on healthcare utilization, compared with the multi-pill combination (MPC) therapy in hypertension (HTN) patients, remains limited. This study compared healthcare utilization among US adults with HTN receiving FDC versus MPC therapy. Methods: We conducted a cross-sectional study on nationally representative data from the Medical Expenditure Panel Survey (2013-2022). Adults aged ≥18 years with a diagnosed HTN on ≥2 antihypertensive classes were classified as FDC or MPC users. Inverse probability of treatment weighting was applied to balance covariates. Weighted negative binomial regression models were used to assess the impact of FDC versus MPC on healthcare utilization, including office-based visits, outpatient visits, emergency department visits, hospitalizations, and prescription fills. A 1:1 propensity score matching (PSM) analysis was conducted as a sensitivity analysis to assess findings robustness. Results: Among 18,269 adults receiving ≥2 antihypertensive therapies, 5,849 were FDC users, and 12,420 were MPC users. Compared with MPC users, FDC users had significantly lower emergency department visits (rate ratio [RR] = 0.712; 95% confidence interval [CI]: 0.636-0.796; p < 0.0001), hospitalizations (RR = 0.721; 95% CI: 0.545-0.953; p = 0.0219), office-based visits (RR = 0.934; 95% CI: 0.879-0.993; p 0.0281), and prescription fills (RR = 0.853; 95% CI: 0.815-0.893; p < 0.0001). No significant difference was observed in the outpatient visit rate. Findings were consistent in PSM analysis. Conclusion: FDC antihypertensive therapy was associated with significantly lower acute care utilization and prescription burden while preserving routine outpatient care, compared with the MPC therapy. These findings support FDC therapy use as a high-value strategy to enhance real-world HTN management and reduce acute healthcare utilization.