To describe current antihypertensive drug therapy in Sweden in relation to gender, age, and comorbidity.Design and method:
By use of the Stockholm County Council database, comprising all healthcare consultations, hospitalizations and dispensed drugs for 2.1 million inhabitants living in the Greater Stockholm region in 2013, we identified all persons >20 years with a recorded diagnosis of hypertension during 2009–2013, their comorbidity, and their dispensed antihypertensive drugs during 2013.Results:
We identified 292 623 patients aged 20–109 (mean 67.8) years, 154 230 (53%) were female. The most common comorbidities in females were diabetes (17%), COPD (17%) and ischemic heart disease (11%), and in males diabetes (24%), ischemic heart disease (17%) and atrial fibrillation (13%). The most common antihypertensive drug classes in females and males were beta blockers (39 and 38%; P < 0.01), calcium channel blockers (29 and 34%; P < 0.001), ACE inhibitors (27 and 36%; P < 0.001), ARB (30 and 29%; P < 0.001) and diuretics (31 and 21%; P < 0.001). The use of beta blockers and diuretics increased with older age, and of ACE inhibitors, ARB, and calcium channel blockers decreased (all P < 0.001). Beta blockers were more common with concomitant ischemic heart disease, atrial fibrillation, and heart failure (70, 74 and 71%, respectively); and ACE inhibitors/ARB were more common with diabetes, heart failure, and TIA/stroke (75, 71 and 64%, respectively). Males with hypertension and diabetes more often received ACE inhibitors/ARB than females, also taking potential confounders into account (79 vs 72%, P < 0.001). The proportions treated with 0,1,2,3 and >4 antihypertensive drug classes were 16,24,29,19,and 12% in females, and 16,18,27,22,and 17% in males. The most common combinations of 2 drugs in females were ARB and diuretics (16%), beta blockers and diuretics (16%), and beta blockers and calcium channel blockers (14%); and in males beta blockers and calcium channel blockers(16%), ARB and diuretics(15%) and ACE inhibitors and diuretics (14%).Conclusions:
Antihypertensive drug therapy reflects concomitant disease. However, gender differences in antihypertensive drug therapy persist. and age and comorbidity do not seem to fully explain these gender differences The use of combination therapy appears low.