ArticleJournal of hypertension2026
Optimizing blood pressure control in multimorbid hypertensive patients: insights from a real-world taiwanese cohort.
Article in Journal of hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveGuidelines 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.
methodsA 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.
resultsOf 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).
conclusionsAntihypertensive 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.
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