USE OF ANTIHYPERTENSIVE DRUG CLASSES DURING THE COVID-19 PANDEMIC. A CROSS-SECTIONAL, NATION-WIDE STUDY 2019-2021

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Objective: To assess changes in the use of antihypertensive drug classes during the COVID-19 pandemic, 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 C02-03, 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. We have excluded patients with a diagnosis of heart failure. The frequencies of use of antihypertensive drug classes – beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), calcium channel blockers (CCB), thiazide diuretics (TD), thiazide-like diuretics (TLD), loop diuretics (LD), mineralocorticoid receptor antagonists (MRA) and alpha-blockers (AB) - and their combinations were analyzed for the years 2019, 2020 and 2021 respectively. Results: In the years 2019, 2020 and 2021 – 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. Among the main groups of antihypertensive drugs, the most used drug groups were BB (62.0, 62.8 and 63.7%), ACEi (52.9, 52.7 and 46.8%) and CCB (34.5, 35.2 and 35.9%). ARB were used by 26.8, 27.3 and 28.2% of patients. Diuretics were used by: TD 14.2, 13.9 and 14.1%; TLD 23.3, 22.8 and 22.6%, LD 13.0, 12.8 and 12.9%, AA 8.5%, 8.3%, 8.5%. AB were rarely used (4.5, 4.5, and 4.5%). Among patients taking two anithypertenisve drugs, the most common combination was BB+ACEi 23.5, 19.7 and 18.7%. BB+other anithypertensive drugs was used by 48.6, 46.9 and 45.7% of patients. ACEi/ARB+TD/TLD and ACEi/ARB+CCB combinations were used by 24.3, 23.4 and 23.6% and 17.4, 17.6 and 18.4% of patients, respectively. Among patients taking three drugs, BB+ACEi/ARB+TD/TLD combination was used by 29.8, 26.4, 25.7% of patients, followed by combinations: BB+ACEi/ARB+CCB 21.3, 19.8 and 19.9% and ACEi/ARB+CCB+TD/TLD 15.2, 17.2 and 18.5% of patients. Conclusions: The COVID-19 pandemic had little impact on changes in the frequency of use of individual antihypertensive drug groups. A slight increase in the use of the two and three drugs’ combinations recommended by the ESC/ESH 2018 guidelines was observed in 2021 compared to 2019.