Impact of covid-19 pandemic on initiation of antihypertensives in Sweden- an interrupted time series study

Background Hypertension is a risk factor for Covid-19, and adequate antihypertensive treatment is of importance. Restrictions during the pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. Aims Assessing the effect of the COVID-19 pandemic on initiation of antihypertensive drugs in Sweden. Methods Data on dispensed prescriptions of diuretics, beta-blockers (BB), calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were extracted from the SCIFIPEARL database linking national registers on drugs and diseases for the entire Swedish population March 2018-November 2021. Interrupted time series analysis was conducted using an autoregressive (ARIMA) model. Monthly cumulative incidence was calculated based on number of patients initiating each drug class after a one-year washout period. Results The analysis included 720300 patients. The start of the pandemic was associated with an immediate statistically significant level decrease in initiation of any antihypertensive, followed by a 0.02-0.06% monthly increase, in both sexes. A significant level decrease was observed for ACEi in both sexes and for all classes except diuretics in patients >65 years. А significant post intervention trend change was observed for initiation of diuretics overall (0.013%), driven mainly by a significant increase in patients >65 years. Similar trend differences were also observed for diuretics in females (0.02%) and ACEi (0.03%) in patients >65 years. Conclusions The pandemic had an immediate short-term effect, but we found no major adverse influence of the COVID-19 pandemic on initiation with antihypertensive drugs.