Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD).
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.
Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Ljungman
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
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Kahan
Institute of Medicine, Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Schiöler
R & D Centre Skaraborg Primary Care, Skövde, Sweden.
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Hjerpe
1] Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden [2] Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden.
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Wettermark
R & D Centre Skaraborg Primary Care, Skövde, Sweden.
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Boström
Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Manhem
D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004522:Educational Status; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology*; D008875:Middle Aged; D012727:Sex Characteristics; D013548:Sweden
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents