Changing patterns of antihypertensive drug use in a German population between 1984 and 1987. Results of a population based cohort study in the Federal Republic of Germany
In the MONICA Augsburg project, a cohort of 3324 men and women randomly selected from the population (aged 30 to 64 y) was surveyed in 1984/85 and in 1987/88. Their antihypertensive medication as well as their demographic characteristics, blood pressure values, and awareness of hypertension were assessed at each visit in an identical manner. In 1984/85 the prevalence of antihypertensive drug use in the cohort was 7.8% (n = 260). In 1987/88, 204 of the hypertensives were still being treated (continuously treated hypertensives) and there were 167 newly treated hypertensives, thus increasing the prevalence of antihypertensive drug use to 11.2%. Of the 204 continuously treated hypertensives, 45.6% had changed their antihypertensive medication over the three-year follow-up period. Combinations with diuretics (except those containing calcium antagonists or ACE-inhibitors) had largely been discontinued, and the prevalence of calcium antagonist mono- and combination therapy had markedly increased from 84/85 to 87/88. Men were treated more frequently with recently introduced antihypertensive agents than women. Newly treated hypertensives (n = 167) showed antihypertensive treatment patterns reflecting the changes observed in continuously treated hypertensives. Triple drug combinations, mostly in fixed ratios, were being taken by approximately 25% of all hypertensives at each visit. Prospective analysis revealed an underlying discontinuation rate of 49%. It is concluded that the epidemiology of antihypertensive therapy in individuals and in the community is subject to rapid changes and various influences. Cohort studies of treated antihypertensive individuals offer a more comprehensive understanding of its determinants.