OBJECTIVES: Single pill combinations (SPC) are associated with improved adherence and persistence in hypertensive (HTN) populations. High adherence and persistence can provide medical benefit for patients and reduce the total health care utilization and costs. This study investigated if Exforge HCT is associated with reduced health care utilization and costs during the 12 months follow up period in adult hypertensive (HTN) patients adherent to treatment. METHODS: A retrospective cohort study was conducted including adult (18 yrs. or older) HTN patients covered by commercial and Medicare Supplemental insurance in the Truven MarketScan database with an HTN diagnosis between October 2009 and December 2011. At least two filled prescriptions for Exforge HCT or two periods of minimum 15 days of concurrent use of amlodipine, valsartan and hydrochlorothiazide (FC cohort) , and at least 80% Medication Possession Ratio(MPR) were required. Chi-Square tests and independent sample t-tests were used after propensity score matching (PSM) (absolute standardized differences (ASM) <0.1) using demographics, comorbidities, pre-index HRU, pre-index costs and valsartan initial dose. RESULTS: Adherent Exforge HCT patients (N=6,004) had better outcomes compared to adherent FC patients (N=1,084) in the 12 months follow up period: less all cause hospitalization (9.2% vs 16.6%, p<0.05; Mean 0.1 vs 0.2, p<0.0001), less all cause ER visits(19.0% vs 29.3%, p<0.05; Mean 0.3 vs 0.6, p<0.0001), less HTN specific ER visits(7.0% vs 12.0%, p<0.05; Mean 0.1 vs 0.2, p<0.0001), less total medical service cost(7247$ vs $10370, p<0.0001), less total prescription drug costs(3926$ vs $5350, p<0.0001) and less total healthcare costs($11173 vs $15720, p<0.0001). After applied PSM, adherent Exforge HCT patients still had lower proportion of all cause hospitalization, all cause ER visit and less number of all prescriptions, p<0.05. CONCLUSIONS: Real-world data indicate that Exforge HCT is associated with less health care utilization and costs compared to amlodipine/valsartan/hydrochlorothiazide FC among patients with adherent treatment of HTN.