Drug treatment of hypertension in Sweden in relation to sex, age, and comorbidity

Abstract

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.

Cardiovascular Disease in Type 2 Diabetes: A Review of Sex-Related Differences in Predisposition and Prevention

“…30,31,33,34,[37][38][39][40][41][42] Few studies have examined the difference in antihypertensive classes between sexes. Women with T2DM are more likely to be prescribed diuretics and beta blockers 43 and less likely to receive angiotensin-converting enzyme inhibitors [44][45][46] and calcium channel blockers than are men with T2DM. 43,47 Dyslipidemia Type 2 diabetes mellitus is associated with a cluster of lipid abnormalities (diabetic dyslipidemia) that include elevated triglyceride levels, decreased high-density lipoprotein (HDL) cholesterol levels, and an increase in 48 It appears to be more frequent in women with T2DM after the age of 60 years than in men with T2DM of the same age group.…”

Antihypertensive drug treatment: the real‐life challenge

“…β-Blockers were more common among patients with atrial fibrillation, coronary artery disease, and heart failure, and angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers were the most frequently administrated drugs in the hypertensive population with diabetes mellitus and heart failure, whereas mineralocorticoid antagonists and diuretics were more frequently used in patients with heart failure. 8 The 14% prevalence rate of hypertension among the study patients is lower than anticipated. In an analysis of global data from population-based cross-sectional surveys, the prevalence rate of hypertension was approximately 26%.…”

“…In the current issue of the Journal of Clinical Hypertension , Wallentin and colleagues analyzed data of antihypertensive drugs use from a registry of more than 2 million patients. The authors noted a 14% prevalence rate of hypertension among all study patients, with an increasing prevalence with age.…”

“…Furthermore, it comes with no surprise that the type of comorbidity was associated with the type of drug class used. β‐Blockers were more common among patients with atrial fibrillation, coronary artery disease, and heart failure, and angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers were the most frequently administrated drugs in the hypertensive population with diabetes mellitus and heart failure, whereas mineralocorticoid antagonists and diuretics were more frequently used in patients with heart failure …”

“…Wallentin and colleagues report that half of the patients with hypertension remain undiagnosed. This assumption is in agreement with data from the aforementioned large registry, where the prevalence rate of hypertension in Sweden was double (28%) that reported in the study .…”