Are hypertensive women with type 2 diabetes treated with RAS inhibitors as often as men? A cross-sectional study in France.

OBJECTIVES: We hypothesise that women with type 2 diabetes and hypertension are less likely than comparable men to receive renin-angiotensin system (RAS)-inhibiting antihypertensive treatment, particularly as first-line therapy. This study's main aim is to investigate the delivery of RAS inhibitor treatments by sex and number of antihypertensive treatments used. DESIGN: Cross-sectional study in a cohort. SETTING: Constances cohort, France, 2012-2019. PARTICIPANTS: 2541 participants with type 2 diabetes among the 196 477 individuals aged 18-69 included in the Constances cohort. OUTCOME MEASURES: Proportion of individuals treated with RAS inhibitors by sex and number of antihypertensive treatments dispensed. Factors associated with the use of RAS inhibitors. RESULTS: Among 2541 diabetics, 1742 (68.6%) had received at least one antihypertensive treatment during the year preceding inclusion-a percentage that did not differ significantly between men and women (p=0.07). In analyses stratified by the number of antihypertensive classes, RAS inhibitors were delivered significantly less often to women than men for single-drug therapy (OR 0.46, 95% CI 0.25 to 0.81; p=0.008) and two-drug therapy (0.35, 95% CI 0.16 to 0.75, p=0.007) but not in regimens of three or more drugs (0.29, 95% CI 0.05 to 1.56; p=0.15). In the multivariate analysis, women received RAS inhibitors significantly less often than men (0.41, 95% CI 0.27 to 0.62; p<0.001). CONCLUSIONS: Women with type 2 diabetes are less likely than men to receive a prescription for RAS inhibitors, although this drug class is recommended as first-line therapy in this population.