Real-World Utilization, Safety, and Early Clinical Reassessment of Antihypertensive Therapy in Primary Care

Background: Hypertension remains one of the leading modifiable risk factors for cardiovascular morbidity and mortality worldwide. Although antihypertensive medications demonstrate substantial efficacy in randomized clinical trials, their real-world use, tolerability, and follow-up patterns are influenced by patient characteristics, treatment regimens, comorbidities, and healthcare utilization. Pharmacoepidemiological evidence from routine primary healthcare remains limited. Objective: To characterize real-world antihypertensive prescribing patterns, evaluate treatment safety, and identify clinical factors associated with early clinical reassessment among patients with hypertension. Methods: This retrospective pharmacoepidemiological study included 1212 adults with hypertension treated in the Family Medicine and Internal Medicine services of the Main Primary Healthcare Center in the Municipality of Obiliq, Kosovo, between January 2024 and July 2026. Demographic characteristics, comorbidities, baseline blood pressure, antihypertensive therapy, dosing frequency, treatment pattern, concomitant medications, statin use, adverse drug reactions, early clinical reassessment within 7–30 days, and hospitalization were evaluated. Categorical associations were examined using chi-square or Fisher’s exact tests, mean blood pressure values across drug classes were compared using one-way ANOVA, and multivariable logistic regression was used to identify factors independently associated with documented adverse drug reactions. Results: The mean age was 63.4 ± 12.5 years; 60.8% of patients were women and 80.1% lived in rural areas. Grade 2 and Grade 3 hypertension accounted for 42.7% and 39.4% of patients, respectively. Losartan 40 mg was the most frequently prescribed medication (56.4%), followed by lisinopril 5 mg (25.7%). Adverse drug reactions were documented in 25.2% of patients and differed significantly across antihypertensive classes (p < 0.001). Early clinical reassessment was recorded in 96.9% of patients with available follow-up information and was significantly associated with treatment pattern and antihypertensive drug class (both p < 0.001). Hospitalization occurred in nine patients and was associated with baseline blood pressure grade (p = 0.014). In multivariable analysis, calcium-channel blocker therapy (adjusted OR 3.67, 95% CI 1.72–7.82) and other antihypertensive classes (adjusted OR 3.72, 95% CI 1.90–7.31) were associated with higher odds of documented adverse reactions, whereas chronic treatment (adjusted OR 0.68, 95% CI 0.50–0.93) and statin use (adjusted OR 0.73, 95% CI 0.54–0.98) were associated with lower odds. Conclusions: This study provides real-world pharmacoepidemiological evidence on antihypertensive prescribing, treatment safety, and early clinical reassessment in primary care. The findings highlight substantial variation in documented adverse reactions across drug classes and support closer, individualized monitoring of antihypertensive therapy in routine clinical practice.