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Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study

Journal of Human Hypertension volume 23, pages 735–742 (2009)Cite this article

Abstract

We studied the profiles of all-cause and cardiovascular (CVS) mortality among users of different antihypertensive classes in a Chinese population. From electronic patient records, a cohort study was conducted among 18 338 patients who ever newly prescribed an α-blocker, thiazide diuretic, β-blocker, calcium channel blocker (CCB) or agents acting on the renin–angiotensin system (RAS) without drug discontinuation or switching in the public primary-care sector in a large Territory of Hong Kong during January 2004–June 2007. The odds ratios of mortality (all-cause and CVS) were evaluated according to the prescribed antihypertensive drug classes by Cox proportional hazards regression analyses. A total of 823 deaths (4.5%) were reported during the study period. The crude proportions of all-cause mortality were highest in α-blockers (6.2%) and CCB (5.7%), but lowest in β-blockers (2.8%). Compared with CCB, patients on thiazide diuretics were shown to have statistically significantly lower all-cause (adjusted hazard ratios (aHRs) 0.75, 95% CI 0.60, 0.93, P=0.010) and CVS mortality (aHR 0.40, 95% CI 0.21, 0.78, P=0.007), but the 95% CI of the odds ratios of the major drug classes overlapped. When each drug class was used as a reference group, or when patients with only uncomplicated hypertension were included, their respective 95% CI similarly overlapped. Antihypertensive drug classes were associated with statistically comparable odds of all-cause and CVS mortality. This finding from real-life clinical practice further supports the position statements from international guidelines, which recommend that the major antihypertensive drug classes are suitable for initiating pharmacotherapy for the management of hypertension.

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Acknowledgements

We acknowledge the support of the Hospital Authority, Hong Kong and the input by colleagues in the Primary Care Research Group of the School of Public Health, Chinese University of Hong Kong for their generous support to this project. SW Mercer conducted this work as visiting Professor in Primary Care Research at the School of Public Health, Chinese University of Hong Kong.

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Authors and Affiliations

  1. School of Public Health and Department of Community and Family Medicine, Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong, China

    J Y Jiang, M C S Wong, X H Zhang, S Griffiths & S Mercer

  2. Hospital Authority, Hong Kong SAR, Prince of Wales Hospital, Shatin, NT, Hong Kong, China

    H Fung

  3. Division of Community-Based Sciences, General Practice and Primary Care, Faculty of Medicine, University of Glasgow, Glasgow, UK

    S Mercer

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  1. J Y Jiang
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  2. M C S Wong
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  3. X H Zhang
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  4. H Fung
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Correspondence to M C S Wong.

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Jiang, J., Wong, M., Zhang, X. et al. Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study. J Hum Hypertens 23, 735–742 (2009). https://doi.org/10.1038/jhh.2009.22

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