Use of antihypertensive drug classes and combination therapies during the COVID-19 pandemic in Poland: a cross-sectional, nation-wide study 2019-2021.

INTRODUCTION:In 2018, hypertension guidelines recommended a more frequent use of combination therapy, especially in a single pill (SPC). OBJECTIVES:Hereby, we assessed the adherence to these recommendations after their publication and during the COVID-19 pandemic in Poland. PATIENTS AND METHODS:The frequencies of use of antihypertensive drug classes and their combinations were analyzed for years 2019, 2020 and 2021 in all patients who filled at least one prescription of an antihypertensive drug based on the database covering all filled prescriptions in Poland. RESULTS:In years 2019, 2020 and 2021 - 10,328,341, 9,478,949 and 9,637,595 patients fulfilled the inclusion criteria. There was a decrease in the rate of patients meeting the criteria for co-prescribing of ≥2 antihypertensive drugs in years 2019, 2020 and 2021 (59.3%, 49.0%, 45.6%, p<0.001).  The combination of renin angiotensin system blockers, calcium channel blockers and/or diuretics was used by 41.7%, 40.9% and 42.0% of patients taking two antihypertensive drugs (p<0.001) and by 15.2, 17.2 and 18.5% of patients taking three antihypertensive drugs (p<0.001). Beta-blockers were used frequently, both overall and among patients using two (48.6, 46.9 and 45.7%, p<0.001) or three antihypertensive medications. Double SPCs were used by 28.0, 28.7 and 29.8% of patients (p<0.001) and triple SPCs by 2.6%, 2.9% and 3.4% of patients (p<0.001). CONCLUSIONS:During the COVID-19 pandemic, a decrease in the frequency of combination treatments and an increase in the frequency of dual and triple SPCs use were observed.  Despite the slow increase in the frequency of use of recommended drug combinations, their use remains inadequate.