OS 22-01Treatment of Hypertension with Low Cardiovascular Risk is associated with significantly lowered mortality.

OBJECTIVE: Treatment of hypertension has been shown to reduce mortality and cardiovascular events in high risk hypertension. However, there is a paucity of evidence on benefit of management for hypertension in patients with low cardiovascular risk. We aimed to determine the benefit in reducing mortality for hypertensive patients without previous cardiovascular disease, diabetes mellitus (DM) or chronic kidney disease (CKD).

DESIGN AND METHOD: Hypertensive patients were selected from Korea National Health Insurance sample cohort, a retrospective cohort selected to be representative of the total eligible Korean population in 2002. The follow up data for up to 11 years until 2013 was analyzed. We analyzed 45120 subjects who did not have CKD, DM, myocardial infarction, unstable angina, heart failure, stroke, and end stage renal disease at baseline. The subject population was divided into 3 groups: group 1: Subjects taking antihypertensive medications at baseline, group 2: Subjects started on anti-hypertensive medication during follow-up, and group 3: subjects who did not take anti-hypertensive medications during the follow-up period. The mortality rate and hazard ratio (HR) according to hypertension treatment were determined.

RESULTS: In 2002, 9938 subjects were not take anti-hypertensive medications and 35182 subjects were taking anti-hypertensive medications. During the follow-up period, anti-hypertensive medication was started on 7756 subjects whereas 2182 subjects remained untreated. Median follow-up duration was 133 months. The mortality rates were 16.4% in group 1, 17.9% in group 2, and 25.5% in group 3. The Kaplan Meier curves revealed a significant difference for mortality between the 3 groups (log-rank p < 0.001). In multivariate Cox analysis, group 1 (HR = 0.41; 95% confidence interval [CI], 0.38-0.45; p < 0.001) and group 2 (HR = 0.37; 95% CI, 0.34-0.41; p < 0.001) were independently associated with reduced mortality after adjustment for age and sex.

CONCLUSIONS: The findings from current study suggest that hypertension medication improves survival in hypertensive patients with relatively low cardiovascular risk.