Evidence mapPaperPMID 41216848Full record

ArticleJournal of hypertension2026

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

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

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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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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Shao-Kai SumDepartment of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.
Yu-Yen OuDepartment of Computer Science and Engineering, Yuan Ze University, Chung-Li.
Yao-Chang WangDepartment of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung.
Tzu-Ping ChenDepartment of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung.
Shao-Wei ChenDepartment of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.
Chi-Hsiao YehDepartment of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

Antihypertensive AgentsBlood PressureHypertensionAdultAgedAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCalcium Channel BlockersCohort StudiesDiureticsFemaleHumansMaleMiddle AgedMultimorbidityTaiwanAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsCalcium Channel BlockersDiureticsantihypertensive therapyblood pressure variabilitycardiometabolic multimorbidityhypertensionmortality

Identifiers

PMID41216848
PMCPMC12672040

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.