Why the study?
Guidelines recommend various antihypertensive classes for hypertension in cardiometabolic multimorbidity, but their effectiveness in Asians is underexplored.
Do specific antihypertensive medication classes and systolic blood pressure targets improve all-cause mortality in Taiwanese patients with hypertension and cardiometabolic multimorbidity?
Do specific antihypertensive medication classes and systolic blood pressure targets improve all-cause mortality in Taiwanese patients with hypertension and cardiometabolic multimorbidity?
In Taiwanese patients with hypertension and cardiometabolic multimorbidity, ARBs are associated with reduced mortality, while intensive SBP control (<120 mmHg) may increase mortality in less complex cases.
OBJECTIVE: Guidelines from ACC/AHA, ESC/ESH, and JNC 8 recommend ACE inhibitors (ACEi), ARBs, calcium channel blockers (CCBs), and diuretics for hypertension in patients with cardiometabolic multimorbidity (CMM). Their effectiveness in Asians is underexplored. This study evaluates their association with mortality in Taiwanese patients with hypertension and CMM. METHODS: A population-based cohort study was conducted using Taiwan's administrative health databases (2004-2014). Patients aged ≥20 years with hypertension and ≥8 outpatient blood pressure measurements were included. All-cause mortality was assessed using inverse probability weighted Cox models, evaluating medication classes, adherence, and systolic blood pressure (SBP) control. RESULTS: Of 80 748 patients (mean age 60 years, 56.3% male), 41.7% had one CMM, and 9.4% had multiple CMMs. ARBs reduced mortality in multimorbid patients [hazard ratio (HR) = 0.80, 95% confidence interval (CI) 0.67-0.95], while diuretics (HR = 1.63, 95% CI 1.33-1.99) and vasodilators (HR = 1.22, 95% CI 1.03-1.45) increased risk. ACEi and CCBs were neutral. Optimal SBP control (120-139 mmHg) benefited multimorbid patients, but intensive control (<120 mmHg) increased risk in those with ≤1 CMM (HR = 1.37, 95% CI 1.20-1.55). High SBP variability (SD >18 mmHg) raised mortality risk (HR = 1.62, 95% CI 1.07-2.44). CONCLUSIONS: Antihypertensive effectiveness varies by CMM burden. ARBs reduce mortality in multimorbid patients, while diuretics and vasodilators may increase risk. Optimal SBP control (120-139 mmHg) benefits multimorbid patients, but intensive control may harm less complex cases. Further research is needed.
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Ou et al. (2025) studied this question.
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