Frequency of Antihypertensive Drug Classes and Single-Pill Combinations in Obese Patients: An 8-Year Retrospective Study

Abstract

Obesity is a major contributor to the development and progression of hypertension, and its coexistence significantly increases cardiovascular risk. Although numerous guidelines exist for the management of arterial hypertension, none are dedicated specifically to obese patients, despite their increasing prevalence. Since 2018, both European and Polish guidelines have recommended the use of single-pill combinations (SPCs) at every stage of treatment. This retrospective study aimed to evaluate antihypertensive treatment patterns over the past eight years among obese patients. This analysis was restricted to obese patients with hypertension to explore prescribing patterns in a subgroup with unique pathophysiological features and high cardiovascular risk, for which specific therapeutic recommendations remain limited. The study cohort was limited to obese patients hospitalized for preoperative assessment prior to planned bariatric surgery. We analyzed medical records of 233 obese hypertensive patients divided into two cohorts: those diagnosed before 2020 and those diagnosed in 2020 or later. We observed a significant increase in the use of three or more antihypertensive drugs and a rise in the prescription of beta-blockers and angiotensin receptor blockers after 2020. Despite these changes, the use of SPCs remained low: two-drug SPCs were used in 35.6% of patients, and three-drug SPCs in only 11.2%, with no significant increase in their use over time. Additionally, SGLT2 inhibitors were introduced into therapy after 2020. Our findings highlight the discrepancy between clinical guidelines and real-world prescribing habits. Improved adherence to treatment recommendations may enhance therapeutic outcomes and medication adherence in this high-risk group.