To describe current antihypertensive drug therapy in Sweden in the very old, in relation to gender, age and comorbidity.
Design and method:
By use of the Stockholm County Council database, comprising all healthcare consultations, hospitalizations, and dispensed drugs for 2.1 million inhabitants living in the Greater Stockholm region in 2013, we identified all persons a recorded diagnosis of hypertension during 2009–2013, their comorbidity, and their dispensed antihypertensive drugs during 2013.
We identified 12 436 patients aged between 90–109 (mean 92.6) years; 9 362 (75%) were women. The most common comorbidities were congestive heart failure (30%), atrial fibrillation (28%) and ischemic heart disease (26%) in women, and atrial fibrillation (37%), congestive heart failure (35%), and ischemic heart disease (34%) in men. The most common antihypertensive drug classes in women and men were diuretics (49 and 49%;), beta blockers (48 and 46%;), calcium channel blockers (30 and 28%), ACE inhibitors (23 and 29%, P < 0.001), ARB (19 and 18%). Beta blockers were more common with concomitant ischemic heart disease, atrial fibrillation, and heart failure (63, 63, and 59%, respectively); whereas ACE inhibitors/ARB were more common with diabetes and congestive heart failure (56 and 52%, respectively). Hypertensive men with diabetes more often than women received ACE inhibitors/ARB (60 vs 52%, P < 0.001). The proportions with 0, 1, 2, 3 and >4 antihypertensive drug classes were 14, 23, 27, 20, and 17% in women, and 15, 22, 25, 21, and 17% in men. The most common combinations of 2 drugs in were beta blockers and diuretics (29%), calcium channel blockers and diuretics (16%), and beta blockers and calcium channel blockers (15%) in women; and in men beta blockers and diuretics (28%), ACE inhibitors and diuretics (17%), and beta blockers and ACE inhibitors (15%).
Antihypertensive drug therapy in the very old is not uncommon. Gender differences in antihypertensive drug therapy persist also in patients aged 90 years and above. Our recent and earlier findings suggest that age and comorbidity do not entirely explain these gender differences. The use of combination therapy appears low.