USE OF ANTIHYPERTENSIVE COMBINATION THERAPY DURING THE COVID-19 PANDEMIC - A CROSS-SECTIONAL, NATION-WIDE STUDY 2019-2021

Abstract

Objective: To assess changes in the use of antihypertensive drug combinations during the COVID-19 pandemic and the degree of adherence to the recommendations of more frequent use of combination therapy by ESC/ESH 2018 guidelines, data of all patients who filled a prescription for an antihypertensive drug in Poland were analyzed. Design and method: Patients who filled at least one prescription from ATC groups C02, C03, C07-10, C10BX in each of the years 2019, 2020 and 2021 were extracted from the obligatory prescription database of the National Health Service in Poland. This database covers all filled prescriptions in Poland. We have excluded from the analysis patients with diagnosis of heart failure. Combination therapy was assumed if prescriptions of two drugs overlapped for at least 40 days. In the case of the use of single pill combinations (SPC), the combined use of the individual substances included in the SPC was automatically recognized by the database. The frequencies were analyzed for the years 2019, 2020 and 2021 respectively. Results: In years 2019, 2020 and 2021 – 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. One antihypertensive drug was used by 28.5, 28.0 and 28.3% of patients. The remaining patients used two antihypertensive drugs 27.4, 28.1 and 28.0%, three antihypertensive drugs 21.6, 22.2 and 22.1%, four antihypertensive drugs 12.7, 12.8 and 12.7% and 5 or more antihypertensive drugs 9.8, 9.0 and 9.0%. There was a modest increase in two drug SPC, which were used by 28.0, 28.7 and 29.8% of patients. There was an increase in the use of three drug SPC – 2.6%, 2.9% and 3.4% of patients. Conclusions: Although a modest, significant increase in the frequency of SPC use, both based on two and three antihypertensive drugs, was found, the COVID-19 pandemic and the ESC/ESH 2018 recommendations supporting the use of combination treatments, have had little impact on the prevalence of combination treatment in Poland.