Sex differences in the prescription of anti-hypertensive medications in primary care patients: an observational study

Background: Pharmacological prescription guidelines for hypertension lack differentiation between the sexes, despite reported sex differences in prevalence, awareness, pathophysiology, and pharmacological response. Aim: To assess prescription patterns of blood pressure-lowering medication among females and males in primary care. Design & setting: In this observational study, which was undertaken in the Netherlands, 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 study included 8596 females and 5788 males. Both females and males were prescribed on average 1.8 antihypertensive agents per person. Females compared with males were prescribed a significantly lower defined daily dosage (1.8 versus 2.1, P<0.001), more often received beta-blockers (35.4% versus 26.3%, P<0.001) and diuretics (53.7% versus 50.5%, P<0.001), while receiving fewer angiotensin-converting enzyme (ACE) inhibitors (35.4% versus 46.3%, P<0.001), and calcium channel blockers (28.5% versus 35.6%, P<0.001). No sex differences were found for angiotensin receptor blockers (24.3 versus 24.4%, P = 0.842). Importantly, females had significantly better controlled hypertension than males (50.2% versus 45.5%, P<0.001). Conclusion: In those pharmacologically treated for elevated blood pressure, differences between females and males exist in defined daily dosage, type of antihypertensive medication, and blood pressure control, with females achieving better hypertension control than males with different type of medication and lower dosage.