Nationwide use of antihypertensive combination therapy in the Czech Republic

Introduction

Arterial hypertension is a major health risk factor. To achieve adequate blood pressure control, most patients require combination therapy with two or more drugs.

Purpose

The aim of this study was to analyse the nationwide use of antihypertensive treatment in the Czech Republic.

Methodology

Nationwide data on all patients treated for arterial hypertension in 2023 in the Czech Republic were obtained from the National Registry of Reimbursable Health Services (NRHZS). Patients who received the diagnosis code I10 as a primary or secondary diagnosis during hospitalization or outpatient care within this period and who were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09, C10BX) were classified as having treated arterial hypertension. Descriptive statistics were used to evaluate the outcomes.

Results

The total number of patients with treated hypertension was 2,233,180 (20,529 per 100,000 inhabitants), and there were 157,203 newly incident patients (1,445 per 100,000 inhabitants) in 2023. Of these, 51% were women; the mean age was 69 ± 13 years, and 59.8% of patients were aged ≥65 years. Most antihypertensive drugs (75%) were prescribed by general practitioners, followed by internists (10%), cardiologists (10%), and other specialists (5%). Treatment with all four major classes of antihypertensive drugs and their combinations is shown in the Figure. Overall, 23.6% of patients were treated with a single drug, 27.2% with two drugs, 27.5% with three drugs, and 11.5% with four antihypertensive drugs. The proportion of fixed-dose combination use was 58.5% for ACE inhibitors/angiotensin receptor blockers, 61.6% for calcium channel blockers, 66.7% for diuretics, and 6.4% for beta-blockers.

Conclusions

In 2023, two thirds of patients (66%) in the Czech Republic were treated with two or more antihypertensive drugs. Both the high prevalence of combination therapy and the approximately 60% use of fixed-dose combinations across most drug classes were substantially higher than contemporary European estimates.

Combinations of antihypertensive drugs