title: Gender differences in antihypertensive drug treatment: results from the Swedish Primary Care Cardiovascular Database (SPCCD).
abstract: There are gender differences in antihypertensive treatment. This study aimed to investigate if gender differences in treatment could be explained by comorbidities. In addition, we aimed to study whether blood pressure control is different in women and men, and whether women interrupt treatment more often with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) compared with men.This cohort study within the Swedish Primary Care Cardiovascular Database included 40,825 patients with hypertension attending primary health care from 2007 to 2008. Cardiovascular comorbidities, with the exception of heart failure, were more common in men. Women were more often treated with diuretics, and men with ACEI, as were hypertensive patients with diabetes. Comorbidities could not entirely explain gender differences in antihypertensive treatment in a regression model. Women had higher systolic and lower diastolic blood pressure; this was also true in subgroups with cardiovascular comorbidity. Men more often than women were prescribed ACEIs/ARBs and interrupted treatment. Women and men are treated with different antihypertensive drugs, and this is not fully explained by differences in comorbidities. Women have higher systolic blood pressures, irrespective of comorbidity. Men have interrupted treatment more often with ACEIs/ARBs. These gender differences could affect outcome and warrant further investigation.
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. Electronic address: Charlotta.ljungman@vgregion.se.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Ljungman
authors.affiliation: Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kahan
authors.affiliation: Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Linus
authors.initials: L
authors.lastname: Schiöler
authors.affiliation: Research and Development Centre Skaraborg Primary Care, Skövde, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Hjerpe
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hasselström
authors.affiliation: Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden; Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.affiliation: Research and Development Centre Skaraborg Primary Care, Skövde, Sweden.
authors.forename: Kristina Bengtsson
authors.initials: KB
authors.lastname: Boström
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Manhem
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D011320:Primary Health Care; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: Antihypertensive drugs; gender; hypertension