Income differences in the type of antihypertensive medicines used in ambulatory settings in Finland: a register-based study

Eur J Clin Pharmacol. 2015 Oct;71(10):1263-70. doi: 10.1007/s00228-015-1911-2. Epub 2015 Jul 31.


Purpose: The objective of this study was to explore income differences in the prevalence of moderate-to-severe hypertension, and among patients, in the use and costs of medicines.

Methods: Personal income was used to classify ≥25-year-old population in quintiles (QI-QV). Patients (N = 497,560) with moderate-to-severe hypertension were identified using special refund entitlements. Medicine use and costs derived from prescription register. Direct standardisation and multivariate regression were used to adjust for demographics and comorbidities.

Results: Low income was associated with higher prevalence of moderate-to-severe hypertension (overall 13%). After adjusting for age, gender, residence, diabetes and coronary heart disease, nearly all patients purchased at least one antihypertensive medicine (93 vs. 96% in QI and QV). Differences in the purchased quantities were small (mean estimates 1028 vs. 1054 defined daily doses (DDDs)/patient/year in QIV and QI). High-income patients were more likely to use angiotensin receptor blockers (37 vs. 54% in QI and QV). Low-income patients were more likely to use beta-blockers (59 vs. 49%, respectively) and ACE inhibitors (35 vs. 28%, respectively). Higher income was associated with higher annual out-of-pocket costs (mean €66 vs. €71 in QI and QV) and reimbursements (€144 vs. €163, respectively).

Conclusions: Use of more expensive medicines contributed to higher costs among patients with higher incomes.

Keywords: Antihypertensive agents; Drug utilisation; Finland; Hypertension; Income; Socioeconomic status.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / economics
  • Adult
  • Aged
  • Ambulatory Care
  • Angiotensin Receptor Antagonists / administration & dosage
  • Angiotensin Receptor Antagonists / economics
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors / economics
  • Antihypertensive Agents / administration & dosage*
  • Antihypertensive Agents / economics*
  • Antihypertensive Agents / therapeutic use
  • Calcium Channel Blockers / administration & dosage
  • Calcium Channel Blockers / economics
  • Comorbidity
  • Drug Utilization
  • Female
  • Finland / epidemiology
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / epidemiology*
  • Income / statistics & numerical data*
  • Male
  • Middle Aged
  • Residence Characteristics


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers