Prognostic impact of the timing of antihypertensive medication initiation for hypertension detected at health screening on primary prevention of adverse cardiovascular events: Age-stratified real-world data analysis

The association between age and timing of antihypertensive treatment initiation and its effect on outcomes of patients with hypertension remain unclear. We investigated the impact of the time to antihypertensive therapy initiation for cardiovascular event primary prevention in an age-stratified analysis using data from a nationwide health claims database. This observational cohort study analyzed claim and health examination data recorded between January 1, 2005, and April 30, 2021, in the Japan Medical Data Center database. Patients with hypertension treated with antihypertensive agents were grouped by time (years) to therapy initiation: <1 (reference group), 1-2, and ≥2. The primary outcome was a composite outcome encompassing cardiovascular death, acute coronary syndrome, heart failure, and cerebrovascular disease. The secondary outcome was all-cause mortality. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals adjusted for the time to treatment (TTI) group, age, male sex, systolic blood pressure, smoking status, dyslipidemia, diabetes, and visceral obesity. Among 520,669 participants, TTI ≥ 1 year conferred significantly higher hazard ratios for primary outcomes than TTI < 1 year in individuals aged ≥40 years. Hazard ratios (95% confidence intervals) for the primary outcome with TTI of 1-2 and >2 years were 1.215 (1.073-1.375) and 1.296 (1.163-1.444) in those aged 40-49 years and 1.268 (1.144-1.406) and 1.341 (1.224-1.468) in those aged 50-59 years, respectively. TTI ≥ 2 years was an independent prognostic factor for the secondary outcome of all-cause mortality in those aged ≥40 years.