Impact of early or delayed anti-hypertensive medication on cardiovascular outcomes for newly detected hypertension in general health screenings: a nationwide population-based study in Korea

AIMS: Hypertension is a significant risk factor for myocardial infarction (MI), stroke, and death. While anti-hypertensive medication is known to reduce these risks, the optimal timing for initiation remains controversial. This study aims to evaluate and compare the outcome risks associated with early vs. delayed anti-hypertensive treatment in a general health screening setting. METHODS AND RESULTS: This study utilized data from 505 212 general health screening examinees without a history of hypertension treatment, MI, and stroke. The population was categorized into normotensive, early treatment (newly diagnosed with hypertension and treated in the same year), and delayed treatment (newly diagnosed but started medication after a year) for hypertension. The risks of MI, stroke, and death were assessed across these groups using Cox proportional hazards models, adjusting for demographic, behavioural, and clinical variables. During the follow-up period (11.34 ± 0.67 years), the incidences of death, MI, and stroke were 6810 (1.3%), 4666 (0.9%), and 7274 (1.4%) subjects, respectively. The hazard ratios (HRs) for MI in the early and delayed treatment groups were 1.52 (1.36-1.69) and 1.56 (1.38-1.76), respectively (P for trend <0.0001). For stroke, the HRs were 1.46 (1.35-1.59) in the early treatment group and 1.58 (1.43-1.74) in the delayed treatment group (P for trend <0.0001). The risk of death was higher in the delayed treatment group with an HR of 1.79 (1.64-1.97) compared with 1.47 (1.35-1.60) in the early treatment group (P for trend <0.0001). CONCLUSION: This study provides population-scale evidence from general health screening participants, encouraging the prompt initiation of anti-hypertensive medication to reduce the risk of adverse outcomes. Delayed consideration of medication in primary health screenings may be associated with higher risks of MI, stroke, and death.