Treatment of uncomplicated hypertension is associated with a reduction in cardiovascularmortality: A Korean national cohort study

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-frombaseline (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.