Dual antihypertensive fixed-dose combinations approved for first-line use on the Pharmaceutical Benefits Scheme 

The December 2025 issue of Australian Prescriber included an editorial that highlighted current gaps in hypertension care and anticipated changes in forthcoming 2026 Australian hypertension guidelines.¹ A key anticipated change is a recommendation to prescribe low-dose combination therapy with 2 antihypertensive drugs as initial treatment for adults requiring pharmacotherapy, ideally as a single-pill or fixed-dose combination, an approach that is now considered international best practice.^2,3

On 1 April 2026, the Pharmaceutical Benefits Scheme (PBS) restrictions were changed to allow fixed-dose combinations of dual antihypertensive therapy to be prescribed as first-line pharmacotherapy for adults with hypertension in Australia.⁴ Previously, access to subsidised dual therapy was limited to patients who had inadequate blood pressure control while on monotherapy. Under the revised arrangements, 30-day prescription items for fixed-dose combinations are now listed as an 'Unrestricted Benefit', while 60-day prescription items remain listed as a 'Restricted Benefit' and are only indicated for patients with stable hypertension.⁴

These changes were recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) following a post-market review of antihypertensive drugs.^5,6 The review examined current prescribing patterns and the comparative cost and effectiveness of starting therapy with a fixed-dose combination versus starting with monotherapy then adding a second therapy.⁶

Enabling the use of fixed-dose combinations as first-line treatment brings Australian prescribing practice in line with international guidelines, which recommend low-dose combination therapy as initial treatment because, compared with monotherapy, it achieves greater blood pressure control and improves long-term adherence.^2,3 This is a key priority area for the National Hypertension Taskforce of Australia as part of its strategy to improve blood pressure control nationally.⁷

Australian hypertension guidelines are currently being updated and are expected to be published in late 2026.⁸ The PBS changes will support implementation of these guidelines by improving subsidised access to recommended first-line therapy.

Further information on the PBS changes, and key findings from the post-market review of antihypertensive utilisation, are available on the PBS website.

 

References

1. Hespe C, Stocks N, Nelson M. Hypertension – a major modifiable and undertreated risk factor. Australian Prescriber 2025;48:194-6.
2. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024;45:3912-4018.
3. Goupil R, Tsuyuki RT, Santesso N, Terenzi KA, Habert J, Cheng G, et al. Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care. Can Pharm J (Ott) 2025;158:188-205.
4. Pharmaceutical Benefits Scheme. PBS restriction changes for antihypertensive dual therapy fixed dose combinations. 2026. [cited 2026 Apr 13]
5. Pharmaceutical Benefits Advisory Committee. Public Summary Document – December 2024 PBAC Meeting. 2024. [cited 2026 Apr 13]
6. University of South Australia Quality Use of Medicines and Pharmacy Research Centre. Final Report – Utilisation analysis of antihypertensives. 2024. [cited 2026 Apr 13]
7. Schutte AE, Bennett B, Chow CK, Cloud GC, Doyle K, Girdis Z, et al. National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030. Med J Aust 2024;221:126-34.
8. National Hypertension Taskforce. Simpler treatment, better outcomes – PBS reforms a critical step forward to improve blood pressure control in Australia. 2026. [cited 2026 Apr 13]