Antihypertensive Drug Use Has Doubled in Past 20 Years

The authors observed notable increases in use for ACE inhibitors (~260%)
The authors observed notable increases in use for ACE inhibitors (~260%)

WASHINGTON, DC—During the past two decades, the use of antihypertensive drugs has "increased remarkably," noted Jens Sundboll, of Aarhus University Hospital, Aarhus, Denmark. Findings from the long-term trend analysis were presented at the ACC.17 Scientific Session. 

Clinical guidelines have undergone modifications with new landmark studies evaluating hypertension. "Whether use of antihypertensive drugs in clinical practice reflects the temporal changes in guidelines are unknown," said Sundboll. To study this, researchers analyzed long-term patterns on the use of antihypertensives in Denmark. 

Using nationwide prescription data, they extracted data on primary care use of angiotensin-converting enzyme (ACE) Inhibitors, angiotensin II receptor blockers (ARB), beta-blockers, diuretics, aldosterone receptor antagonists, and calcium channel blockers (CCB) during 1999–2015. 

An increasing trend of antihypertensive use per 1,000 inhabitants/day was seen during the 17-year period, from 184 to 379 defined daily doses (DDD). This correlated to a rise in the proportion of users in the entire Danish population from ~20% to ~35%. 

Study authors observed notable increases in use for ACE inhibitors from 29 to 105 DDD per 1,000 inhabitants/day (~260%) and ARBs from 13 to 73 DDD per 1,000 inhabitants/day (~520%). The use of diuretics, however, remained consistent with a small decreasing tendency from 91 to 85 DDD per 1,000 inhabitants/day (~–10%). The use of aldosterone receptor antagonists showed an increase until 2007 then stayed stable at 3.5 DDD per 1,000 inhabitants/day thereafter (~65%). There was a 2-fold increase in the use of beta-blockers during the study period from 17 to 34 DDD per 1,000 inhabitants/day (~100%), "entirely driven by increasing use of metoprolol," noted Sundboll. A similar trend was seen for CCBs with an increase from 34 to 82 DDD per 1,000 inhabitants/day (~140%) where amlodipine was responsible for driving the overall rise. 

Changes in antihypertensive use were driven by certain drugs within the antihypertensive drug class. The trends correlated with the availability data from landmark studies for the treatment of hypertension and congestive heart failure.