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 angiotensin-converting 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.

Keywords: antihypertensive agents; blood pressure; cardiovascular disease; diabetes mellitus; hypertension; primary health care; sex; treatment.

Figure 1

Prevalence of diagnosed hypertension, according to age and sex. The solid line represents the total number of patients with hypertension per age group. The filled bars represent women and the open bars men.

Figure 2

Proportion of patients attending different care providers. Data for 292 623 patients with a recorded diagnosis of hypertension in the greater Stockholm region, Sweden, any time during the years 2009–2013, who were alive at the end of 2013. There is an overlap between primary health care, specialist ambulatory care, and inpatient care.

Figure 3

Comorbidity for women 154 230 women and 138 393 men with a recorded diagnosis of hypertension in the greater Stockholm region, Sweden, any time during the years 2009–2013. No cardiovascular or diabetic comorbidity was recorded in 56.3% of women and 48.9% of men. AF indicates atrial fibrillation or flutter; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; HTN, hypertension; IHD, ischemic heart disease; TIA, transient ischemic attack.

Figure 4

Dispensed drug classes, according to sex and age for 292 623 patients with a recorded diagnosis of hypertension in the greater Stockholm region, Sweden, any time during the years 2009–2013. Amiloride was considered a diuretic, whereas mineralocorticoid receptor antagonist (MRA) was recorded separately. Other antihypertensive drugs were mostly doxazosin and moxonidine. ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker.