Chan J Lee1, Jinseub Hwang, Jaewon Oh, Sang-Hak Lee, Seok-Min Kang, Donghoon Choi, Hyeon-Chang Kim, Sungha Park. 1. aDivision of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul bDepartment of Computer Science and Statistics, Daegu University, Gyeongsan, Gyeongbuk cDepartment of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Abstract
BACKGROUND: Although the benefit of hypertension treatment is well established in high-risk patients, there is a paucity of evidence regarding the benefit of treatment in patients with uncomplicated hypertension. METHODS: Hypertensive adult patients were selected from the Korea National Health Insurance Sample Cohort in 2002 and were followed until 2013. Patients with a diagnosis of heart failure, coronary artery disease, stroke, malignancy, diabetes, or chronic kidney disease were excluded. Ultimately, 40 496 patients were divided into three groups: never-treated (N = 6756), treated-from-baseline (N = 28 443), and treated-during-follow-up (N = 5297). Five first-line antihypertensive agents were categorized into four classes: renin-angiotensin system blocker (RASB), beta-blocker, calcium channel blocker (CCB), and diuretics. All-cause mortality, cardiovascular mortality, and hazard ratio were determined. RESULTS: All-cause and cardiovascular mortality rates were significantly lower in both treatment groups than in the never-treated group (all log-rank P < 0.001). Treatment from baseline (hazard ratio = 0.49 for all-cause mortality and hazard ratio = 0.62 for cardiovascular mortality) and treatment started during follow-up (hazard ratio = 0.41 for all-cause mortality and hazard ratio = 0.44 for cardiovascular mortality) were independently associated with lower mortality on multivariable Cox analyses. Although RASB, beta-blocker, and CCB significantly reduced all-cause mortality, multivariable Cox analyses showed that RASB and CCB were closely associated with lower all-cause mortality. In terms of cardiovascular mortality, only CCB was associated with lower cardiovascular mortality on multivariable Cox analyses. CONCLUSION: Treatment of hypertension significantly reduces mortality in patients with uncomplicated hypertension.
BACKGROUND: Although the benefit of hypertension treatment is well established in high-risk patients, there is a paucity of evidence regarding the benefit of treatment in patients with uncomplicated hypertension. METHODS:Hypertensive adult patients were selected from the Korea National Health Insurance Sample Cohort in 2002 and were followed until 2013. Patients with a diagnosis of heart failure, coronary artery disease, stroke, malignancy, diabetes, or chronic kidney disease were excluded. Ultimately, 40 496 patients were divided into three groups: never-treated (N = 6756), treated-from-baseline (N = 28 443), and treated-during-follow-up (N = 5297). Five first-line antihypertensive agents were categorized into four classes: renin-angiotensin system blocker (RASB), beta-blocker, calcium channel blocker (CCB), and diuretics. All-cause mortality, cardiovascular mortality, and hazard ratio were determined. RESULTS: All-cause and cardiovascular mortality rates were significantly lower in both treatment groups than in the never-treated group (all log-rank P < 0.001). Treatment from baseline (hazard ratio = 0.49 for all-cause mortality and hazard ratio = 0.62 for cardiovascular mortality) and treatment started during follow-up (hazard ratio = 0.41 for all-cause mortality and hazard ratio = 0.44 for cardiovascular mortality) were independently associated with lower mortality on multivariable Cox analyses. Although RASB, beta-blocker, and CCB significantly reduced all-cause mortality, multivariable Cox analyses showed that RASB and CCB were closely associated with lower all-cause mortality. In terms of cardiovascular mortality, only CCB was associated with lower cardiovascular mortality on multivariable Cox analyses. CONCLUSION: Treatment of hypertension significantly reduces mortality in patients with uncomplicated hypertension.