{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:43:47Z","timestamp":1790707427889,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Hypertension is a leading modifiable risk factor for cardiovascular mortality worldwide. This study aimed to evaluate 25\u2010year trends in antihypertensive agent (AHA) utilization in Croatia between 2000 and 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a national, population\u2010based analysis using IMS and IQVIA pharmaceutical databases. Drug utilization was measured in defined daily doses per 1000 inhabitants per day (DDD\/1000\/day), alongside trends in financial expenditure and prescribing patterns.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2000 and 2024, total AHA utilization tripled, increasing from 144.57 to 439.13 DDD\/1000\/day. Agents acting on the renin\u2013angiotensin system (RAS) were the most prescribed class throughout the period, with prescribing volumes rising by 335%, largely driven by increased utilization of fixed\u2010dose combinations. Class shifts included a growing uptake of \u03b2\u2010blockers and RAS inhibitors, alongside a relative decline in calcium channel blockers and diuretics. Total national expenditure on AHAs increased from \u20ac53.62 million in 2000 to \u20ac96.61 million in 2024, reflecting evolving market dynamics and a sustained decrease in average drug prices per DDD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These changes were related to the broader access to AHAs, and an expanding role for combination therapy, but regimens did not completely parallel the introduction of updated international guidelines. Nevertheless, demographic pressures, clinical inertia and policy\u2010related barriers continue to constrain optimal blood pressure control. Our findings highlight the importance of aligning national prescribing practices with clinical evidence and health system reforms to improve long\u2010term cardio\u2010kidney\u2010metabolic outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bcp.70196","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T02:00:01Z","timestamp":1754964001000},"source":"Crossref","is-referenced-by-count":1,"title":["Trends in 25 years of antihypertensive agent utilization in Croatia \u2013 an alert for scientific community and healthcare providers"],"prefix":"10.1002","author":[{"given":"Andrej","family":"Belan\u010di\u0107","sequence":"first","affiliation":[{"name":"Department of Basic and Clinical Pharmacology and Toxicology University of Rijeka, Faculty of Medicine  Rijeka Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta Ku\u010dan","family":"\u0160tigli\u0107","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Pharmacology and Toxicology University of Rijeka, Faculty of Medicine  Rijeka Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Jelakovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Rijeka  Rijeka Croatia"},{"name":"Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation University Hospital Center Zagreb  Zagreb Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bojan","family":"Jelakovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation University Hospital Center Zagreb  Zagreb Croatia"},{"name":"School of Medicine University of Zagreb  Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinko","family":"Vitezi\u0107","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Pharmacology and Toxicology University of Rijeka, Faculty of Medicine  Rijeka Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae178"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2024.05.033"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012848"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)01225\u20108"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000378"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.14545"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15153"},{"issue":"3","key":"e_1_2_10_10_1","first-page":"287","article-title":"Arterijska hipertenzija u Hrvatskoj. Rezultati EH\u2010UH studije [Arterial hypertension in Croatia. Results of EH\u2010UH study]","volume":"61","author":"Jelakovi\u0107 B","year":"2007","journal-title":"Acta Med Croat"},{"key":"e_1_2_10_11_1","unstructured":"Jelakovi\u0107B.Prevalence awareness treatment and control of hypertension in Croatia (EHUH 2). (unpublished data results presented at the Annual Meeting of the Croatian Hypertension League).2023."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/08037051.2024.2371863"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jhh.1002089"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2019.1567338"},{"key":"e_1_2_10_15_1","unstructured":"https:\/\/atcddd.fhi.no\/filearchive\/publications\/2024_guidelines__final_web.pdf. Accessed May 12 2025."},{"key":"e_1_2_10_16_1","unstructured":"https:\/\/podaci.dzs.hr\/hr\/podaci\/stanovnistvo\/. 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Accessed June 22 2025."},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2110730"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bcp.70196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T04:10:53Z","timestamp":1756181453000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1002\/bcp.70196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":18,"alternative-id":["10.1002\/bcp.70196"],"URL":"https:\/\/doi.org\/10.1002\/bcp.70196","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"value":"0306-5251","type":"print"},{"value":"1365-2125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]},"article-number":"bcp.70196"}}