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Fixed-Dose Combinations for Hypertension: Barriers to Use and Opportunities for Health Systems
Pranay Narang1,2, Josselyne Marquez3, Neema Rashidi1
1University of California, Berkeley, University of California, San Francisco Joint Medical Program, Berkeley, California, USA.
Journal of Clinical Hypertension (Greenwich, Conn.)
|June 2, 2026
Summary
Fixed-dose combinations (FDCs) for hypertension are underutilized due to systemic barriers and provider misconceptions. Implementing targeted educational and system-level changes can improve FDC adoption and patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Pharmacology
Background:
- Uncontrolled hypertension significantly contributes to severe cardiovascular and renal diseases.
- Fixed-dose combinations (FDCs) are recommended for hypertension management to enhance adherence and efficacy.
- Despite guidelines, FDC use is low in U.S. health systems, with limited research on barriers.
Purpose of the Study:
- To identify structural and provider-level barriers to fixed-dose combination (FDC) utilization in hypertension management.
- To develop stakeholder-informed recommendations for increasing FDC uptake in health systems.
Main Methods:
- Conducted semi-structured interviews with healthcare providers, population health stakeholders, and health system executives.
- Utilized thematic analysis to identify barriers and inform recommendations for FDC utilization.
Main Results:
- Identified structural barriers: limited training exposure, ingrained monotherapy culture, workflow issues, fragmented formularies, and lack of incentives/endorsements.
- Clinicians reported low FDC use and concerns about dosage flexibility, contrasting with pharmacists and NPs who recognized FDC benefits.
- Discrepancies in FDC familiarity and perceived advantages highlight a gap between provider groups.
Conclusions:
- Integrate FDC education into medical and pharmacy curricula.
- Implement electronic health record decision support for FDCs.
- Expand team-based care models for medication management.
- Secure leadership support, create provider incentives, and establish tracking mechanisms.
- Promote FDC adoption through champions, continuing education, and socialization.
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