Predictors of the incidence of all-cause mortality and deaths due to diabetes and renal diseases among patients newly prescribed antihypertensive agents: a cohort study.
BACKGROUND
Randomized trials have shown that the major antihypertensive drug classes are similarly effective to reduce mortality, but whether these drug class difference exists in clinical practice has been scarcely explored. This study evaluated the association between antihypertensive drug class, all-cause mortality and deaths due to diabetes or renal disease in real-life clinical settings.


METHODS
A clinical database in Hong Kong included all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 from the public healthcare sector. All patients were followed up for five years, and grouped according to the initial antihypertensive prescription. The associations between antihypertensive drug class, all-cause mortality or combined diabetes and renal mortality, respectively, were evaluated by Cox proportional hazard models.


RESULTS
From 218,047 eligible patients, 33,288 (15.3%) died within five years after their first-ever antihypertensive prescription and among which 1055 patients (0.48%) died of diabetes or renal disease. After adjusted for age, gender, socioeconomic status, service settings, district of residence, medication adherence, and the number of comorbidities, each drug class was similarly likely to be associated with mortality due to diabetes or renal disease [Adjusted Hazard Ratios (AHR) ranged from 0.92 to 1.73, p=0.287-0.939] and all-cause mortality (AHR ranged from 0.83 to 1.02) except for beta-blockers (AHR=0.815, 95% C.I. 0.68-0.87, p=0.024) when ACEI was used as a reference group in propensity score-adjusted analysis.


CONCLUSIONS
These findings provide real-life evidence reinforcing that any major antihypertensive drug class is suitable as a first-line agent for management of hypertension as recommended by international guidelines.
Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Martin C S
MC
Wong
Wilson W S
WW
Tam
Harry H X
HH
Wang
Clement S K
CS
Cheung
Ellen L H
EL
Tong
Antonio C H
AC
Sek
N T
NT
Cheung
Bryan P Y
BP
Yan
C M
CM
Yu
Stephen R
SR
Leeder
Sian M
SM
Griffiths
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002423:Cause of Death / Q000639:trends; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D007674:Kidney Diseases / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends
D000959:Antihypertensive Agents; D055553:Prescription Drugs
All-cause mortality; Antihypertensive drug class; Diabetes mellitus; Renal disease