Sex differences in the prescription of anti-hypertensive medications in primary care patients

Background Pharmacological prescription guidelines for hypertension lack differentiation between the sexes, despite reported sex differences in prevalence, awareness, pathophysiology and pharmacological response.

Aim We aimed to assess prescription patterns of blood pressure lowering medication among women and men in primary care.

Design & setting We analysed data collected in 2018 during routine primary care practice among those pharmacologically treated for elevated blood pressure, and free from cardiovascular comorbidities or diabetes mellitus.

Method We assessed sex differences in the number of prescribed drugs, defined daily dosage, type of antihypertensive medication, and blood pressure control. We adjusted for differences between sexes in age and other covariates.

Results This observational study included 8596 women and 5788 men. Both women and men were prescribed on average 1.8 antihypertensive agents per person. Women compared to men were prescribed a significantly lower defined daily dosage (1.8 vs 2.1, P<0.001), received more often betablockers (35.4% vs 26.3%, P<0.001) and diuretics (53.7% vs 50.5%, P<0.001), while receiving fewer ACE-inhibitors (35.4% vs 46.3%, P<0.001) and calcium channel blockers (28.5% vs 35.6%, P<0.001). No sex differences were found for angiotensin receptor blockers (24.3 vs. 24.4%, P=0.842). Importantly, women had significantly better controlled hypertension than men (50.2% vs 45.5%, P<0.001).

Conclusion In those pharmacologically treated for elevated blood pressure, differences between women and men exist in defined daily dosage, type of antihypertensive medication, and blood pressure control, with women achieving better hypertension control than men with different type of medication and lower dosage.