The evolution of hypertension treatment in Belgium, a pharmacoepidemiological study

The aim of this paper is to study the number of patients treated for hypertension and the evolution in usage of different classes of antihypertensive medication.

Data from 1997 to 2009 was extracted from Pharmanet, a nation-wide database of prescriptions of reimbursed medication in Belgium.

In 2009, 25% of women and 20% of men were prescribed at least one antihypertensive drug. Prescription rates rose with age but already 25% of the population aged between 41 and 60 years were treated. More than 50% of the Belgians above 60 years took antihypertensive medication. From 1997 to 2009, a rise in absolute prescription rate was observed for all antihypertensive drug classes. Diuretics and beta blockers remain by far the most frequently delivered drugs with stable prescription rates of 30% over this period. The largest rise is observed for angiotensin II receptor blockers (ARBs), which were only sporadically prescribed in 1997 and now account for 10.5% of the delivered antihypertensive drugs. A small rise is also noted for angiotensin-converting enzyme inhibitors (ACE-inhibitors) (12.3% in 1997 vs 15.6% in 2009). Their success comes at the expense of calcium antagonists, of which the delivered amount declined from 19.8% in 1997 tot 14.1% in 2009. A progressive rise in the prescription of fixed combination products is observed (from 15% in 1997 to 21% in 2009), and can probably be attributed to their growing availability but also to the recent guidelines, promoting their usage.

Above age 60, the majority of the Belgians are treated with antihypertensive medication. There is a growing tendency for the use of renin angiotensin aldosterone system (RAAS) blockers and fixed combination products.