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

Shao-Kai Sum1, Yu-Yen Ou2, Yao-Chang Wang3

  • 1Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.

Journal of Hypertension
|November 11, 2025
PubMed

Insights

Angiotensin II receptor blockers (ARBs) reduce mortality in Taiwanese patients with hypertension and cardiometabolic multimorbidity (CMM). Diuretics and vasodilators may increase risk, while optimal blood pressure control benefits those with CMM.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Current hypertension guidelines recommend ACE inhibitors (ACEi), ARBs, CCBs, and diuretics for patients with cardiometabolic multimorbidity (CMM).
  • The effectiveness of these antihypertensive medications in Asian populations, particularly those with CMM, remains underexplored.

Purpose of the Study:

  • To evaluate the association between different classes of antihypertensive medications and all-cause mortality in Taiwanese patients with hypertension and CMM.
  • To assess the impact of systolic blood pressure (SBP) control and variability on mortality risk in this population.

Main Methods:

  • A population-based cohort study utilizing Taiwan's administrative health databases from 2004 to 2014.
  • Inclusion criteria: patients aged ≥20 years with hypertension and ≥8 outpatient blood pressure measurements.
  • All-cause mortality was analyzed using inverse probability weighted Cox models, examining medication classes, adherence, and SBP control.

Main Results:

  • Angiotensin II receptor blockers (ARBs) were associated with reduced mortality in patients with CMM (HR=0.80).
  • Diuretics (HR=1.63) and vasodilators (HR=1.22) were linked to increased mortality risk; ACE inhibitors and CCBs showed neutral effects.
  • Optimal SBP control (120-139 mmHg) benefited multimorbid patients, whereas intensive control (<120 mmHg) increased risk in less complex cases. High SBP variability also raised mortality risk.

Conclusions:

  • The effectiveness of antihypertensive medications varies significantly based on the burden of cardiometabolic multimorbidity.
  • ARBs demonstrate a mortality-reducing benefit in multimorbid patients, contrasting with potential risks associated with diuretics and vasodilators.
  • Optimal SBP control is crucial for patients with CMM, but intensive blood pressure lowering may pose risks in less complex hypertensive individuals.
Abstract

Keywords:
antihypertensive therapyblood pressure variabilitycardiometabolic multimorbidityhypertensionmortality

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