Population Trends of New Prescriptions for Antihyperglycemics and Antihypertensives Between 2014 and 2022

Abstract

Background: In the wake of pandemic-related health decline and health care disruptions, there are concerns that previous gains for cardiovascular risk factors may have stalled or reversed. Population-level excess burden of drug-treated diabetes and hypertension during the pandemic compared with baseline is not well characterized. We evaluated the change in incident prescription claims for antihyperglycemics and antihypertensives before versus during the pandemic.

Methods and results: In this retrospective, serial, cross-sectional, population-based study, we used interrupted time series analyses to examine changes in the age- and sex-standardized monthly rate of incident prescriptions for antihyperglycemics and antihypertensives in patients aged ≥66 years in Ontario, Canada, before the pandemic (April 2014 to March 2020) compared with during the pandemic (July 2020 to November 2022). Incident claim was defined as the first prescription filled for any medication in these classes. The characteristics of patients with incident prescriptions of antihyperglycemics (n=151 888) or antihypertensives (n=368 123) before the pandemic were comparable with their pandemic counterparts (antihyperglycemics, n=97 015; antihypertensives, n=146 524). Before the pandemic, monthly rates of incident prescriptions were decreasing (-0.03 per 10 000 individuals [95% CI, -0.04 to -0.01] for antihyperglycemics; -0.14 [95% CI, -0.18 to -0.10] for antihypertensives). After July 2020, monthly rates increased (postinterruption trend 0.31 per 10 000 individuals [95% CI, 0.28-0.34] for antihyperglycemics; 0.19 [95% CI, 0.14-0.23] for antihypertensives).

Conclusions: Population-level increases in new antihyperglycemic and antihypertensive prescriptions during the pandemic reversed prepandemic declines and were sustained for >2 years. Our findings are concerning for current and future cardiovascular health.

Keywords: COVID‐19; diabetes; hypertension; pharmacotherapy; time trends.

Figure 1. Age‐ and sex‐standardized rates of monthly incident prescriptions for antihyperglycemics or antihypertensives per 10 000 individuals.

Gray shade represents the interruption period from April to July 2020. GLP‐1RA indicates glucagon‐like peptide 1 receptor agonist; and SGLT2i, sodium‐glucose cotransporter‐2 inhibitor.

Figure 2. Age‐ and sex‐standardized monthly rates of HbA_1c test per 10 000 individuals ≥66 years of age.

HbA_1c indicates glycated hemoglobin.