Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

Abstract

The reasons why women and men are treated with different antihypertensive drugs are not clear. Whether socioeconomic factors influence prescription patterns and blood pressure control differently in women and men has not been investigated. This cross-sectional study performed in a cohort of hypertensive patients from the Swedish Primary Care Cardiovascular Database (SPCCD) examined the influence of educational level, country of birth, gender and concomitant psychiatric disorder on prescription pattern and blood pressure control in 40,825 hypertensive patients. Men were more often than women treated with calcium channel blocker and angiotensin-converting enzyme inhibitor (ACEI), irrespective of education, country of birth and psychiatric disorder. Educational level influenced the prescription pattern to some extent, where the gender differences were reduced in patients with a higher educational level. In women, but not in men, high educational level and concomitant psychiatric disorder were associated with a higher proportion reaching target blood pressure. The predominant use of ACEI and calcium channel blockers in men is not influenced by educational level, country of birth or psychiatric disorder. Thus other explanations must be considered such as gender differences in side effects. Educational level seems to have a greater impact on reaching target blood pressure in women compared with men.

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

“…This might be attributable to other concomitant symptoms and conditions (eg, migraine and palpitations) but remains to be examined. Our findings on dispensed antihypertensive drugs are in agreement with other results from Sweden and other countries . The results indicate that concomitant cardiovascular disease and diabetes mellitus influence the choice of antihypertensive drug classes, as expected.…”

“…Our findings on dispensed antihypertensive drugs are in agreement with other results from Sweden and other countries. 27,28 The results indicate that concomitant cardiovascular disease and diabetes mellitus influence the choice of antihypertensive drug classes, as expected. However, compared with men, fewer women with concomitant diabetes mellitus and with heart failure were taking ACEIs/ARBs.…”

Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use

“…We have previously presented the formal properties of this design, 27 which has been used both explicitly 28–31 and implicitly 32, 33 in many prior studies. This method identifies a dynamic cohort of individuals, drawn from a given source population, who in principle could have been enumerated in the past and followed to the present (termed the “conceptual cohort”).…”

Gender Differences in Cardiovascular Drugs

“…The latter family of drugs includes the angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) and the renin inhibitor, aliskiren. Although no gender differences in pharmacokinetics or pharmacodynamics have been described for RAAS inhibitors or diuretics [73,74], prescribing differences in these medications appear to be gender related [75,76]. Among hypertensive patients, men are more likely to be treated with RAAS inhibitors, while women are more likely to be prescribed a diuretic, even after controlling for age and comorbidities [75,76].…”

“…Although no gender differences in pharmacokinetics or pharmacodynamics have been described for RAAS inhibitors or diuretics [73,74], prescribing differences in these medications appear to be gender related [75,76]. Among hypertensive patients, men are more likely to be treated with RAAS inhibitors, while women are more likely to be prescribed a diuretic, even after controlling for age and comorbidities [75,76]. One reason for these differences may relate to the potential teratogenic and abortive effects of RAAS inhibitors in women of child bearing years, and the reluctance of health providers to prescribe such RAAS -targeting medications without assurances of adequate birth control [77][78][79][80].…”