Gender, age and regional disparities in antihypertensive prescribing and medication adherence: evidence from linked survey and claims data

Background

Hypertension affects an estimated 25.0% of women and 34.4% of men aged 30–79 in Germany [1]. Medication non-adherence remains a major barrier to effective blood pressure control [2], with over half of patients newly treated for hypertension classified as non-adherent within two years [3]. Deviations from guideline recommendations in prescribing single-pill combinations (SPCs) are common [4]. Beta-blockers are prescribed more frequently to women without cardiovascular comorbidities [5], and the prevalence of hypertension varies by residential area [6]. The extent of these disparities in routine care remains insufficiently characterised.

Purpose

This study examines the association between sociodemographic determinants and medication adherence and guideline-concordant antihypertensive prescribing in statutorily insured patients with documented hypertension.

Methods

A cross-sectional analysis was conducted using linked survey and statutory health insurance claims data from insured individuals with documented hypertension (ICD-10: I10) in 2022. Participants were recruited via stratified random sampling by gender, age and residential type. Prescription patterns were extracted from the claims data for the period from 2022 to 2023. The concordance of the ESC/ESH Guideline (2018) was assessed based on the use of SPCs and beta-blocker prescribing patterns in patients without cardiovascular comorbidities. Medication adherence was assessed using a validated questionnaire (Ude et al., 2013). Associations with sociodemographic factors were analysed using chi-square tests and logistic regression.

Results

Overall, 38.9% of 1,504 participants were non-adherent. Non-adherence was markedly higher in patients under 50 years old (54.8%) than in those aged 50 and over (27.4%; p<0.001). Of the 366 patients with uncomplicated hypertension in 2023, 14.8% received no antihypertensive medication, while 38.0% received monotherapy only. SPCs were used by 24.6% of patients (9.6% SPC only and 15.0% SPC combined with other agents), while 22.1% received free pill combination without SPCs.

In 2023, 32.5% of 366 patients with uncomplicated hypertension were prescribed beta-blockers. These were significantly more prevalent among women (41.3%) than men (23.2%; p<0.001). For beta-blockers, female gender and rural residence were identified as independent predictors in a logistic regression analysis (p<0.05).

Conclusions

Gender and regional disparities in beta-blocker prescribing persist among patients with uncomplicated hypertension, and SPCs use remains low. Non-adherence is particularly prevalent among younger patients in the overall cohort. These findings highlight the need for greater guideline concordance in prescribing and age-specific support to improve medication adherence.