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Publications

Journal Article Ahead of print

PubMed: 41216848 DOI: 10.1097/HJH.0000000000004156

Optimizing blood pressure control in multimorbid hypertensive patients: insights from a real-world taiwanese cohort.

J Hypertens

Authors: Shao-Kai Sum, Yu-Yen Ou, Yao-Chang Wang, Tzu-Ping Chen, Shao-Wei Chen, Chi-Hsiao Yeh

Affiliations

  • Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.
  • Department of Computer Science and Engineering, Yuan Ze University, Chung-Li.
  • Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung.
  • Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan. School of Medicine, Chang Gung University. Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
  • School of Medicine, Chang Gung University.

Abstract

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.

MeSH

Diabetes Mellitus, Hypertension, Mortality, Blood, Calcium Channel Blockers, Myocardial Infarction, Blood Pressure, Angiotensin Receptor Antagonists, Diuretics, Vasodilator Agents