The authors investigated antihypertensive drug treatment in Sweden using the Stockholm Regional Healthcare Data Warehouse, providing information on all healthcare consultations, diagnoses, hospitalizations, dispensed prescription drugs, sex, and age in 2.1 million persons. This cross-sectional analysis identified 292 428 individuals 20 years or older with hypertension (mean age 68 ± 13 years, 53% women). About half had no diabetes mellitus or cardiovascular comorbidity. The number of dispensed drugs was lower in women than in men (1.9 ± 1.3 vs 2.1 ± 1.5, P < .001). Women more often used diuretics, angiotensin receptor blockers, and β-blockers, while men used more angiotensin-converting enzyme inhibitors and calcium channel blockers (all P < .01). In women, 66% with diabetes mellitus and 72% with heart failure used angiotensinconverting enzyme inhibitors/angiotensin receptor blockers vs 76% and 79% in men (all P < .001, adjusted for age and comorbidity). Thus, sex differences in treatment prevail.There is room for improvement, which could reduce cardiovascular complications.

Purpose: To describe current antihypertensive treatment in very old hypertensive patients according to sex and comorbidity. Materials and methods: We used the Stockholm regional healthcare data warehouse (Vårdanalysdatabasen) providing information on all healthcare consultations, diagnoses, hospitalizations, dispensed prescription drugs, sex and age in 2.1 million people living in the greater Stockholm region, Sweden. This cross-sectional analysis identified 12,436 individuals with a diagnosis of hypertension, who were 90 years or older. Results: Mean age was 92.6 ± 2.6 years, 75% were women; and 34% of women and 24% of men had no diagnoses of concomitant diabetes or cardiovascular disease. The number of dispensed drug classes was similar (2.1 ± 1.4) in women and in men. Women more often used angiotensin receptor blockers and beta-blockers, while men more frequently used ACE inhibitors and calcium channel blockers (all p < .05). Compared to men, women with concomitant diabetes or heart failure used less ACE inhibitors or angiotensin receptor blockers (52 vs. 60% and 49 vs. 55%, respectively; all p < .01and adjusted for age and comorbidity), which is contrary to current recommendations. Conclusion: Our findings suggest that antihypertensive treatment is common also in very old patients. Given the rapidly ageing population and circumstantial evidence in favour of maintaining well-tolerated antihypertensive therapy in very old patients, prospective well-designed outcome studies are warranted.

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