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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Special Issue: Current evidence and perspectives for hypertension management in Asia

Diuretics versus others for long-term clinical outcomes as first-line antihypertensive medications: analysis of national real-world database

Hypertension Research volume 45, pages 758–768 (2022)Cite this article

Abstract

Although several large trials that included African American patients with hypertension have demonstrated the superiority of diuretics as an initial monotherapy, its applicability to other ethnicities remains questionable. The purpose of this study was to investigate whether diuretics as first-line antihypertensive medications are superior to other classes of drugs in the Korean population. Using the Korean National Health Insurance Service database, we analyzed 95,201 Korean hypertensive patients without prior history of cardiovascular disease who started a single antihypertensive drug between January 2002 and December 2017. The primary endpoint was a composite of cardiovascular death, myocardial infarction and stroke. Each endpoint was compared among five classes of antihypertensive drugs [diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and beta-blockers (BBs)]. In multivariable Cox analysis, diuretics were superior to ACEIs (hazard ratio [HR], 1.58–2.01), inferior to ARBs (HR, 0.37–0.43) and similar to CCBs and BBs for the primary endpoint. Similar findings were obtained for all-cause and cardiovascular mortality and stroke. This result was consistently observed in the longer treatment group and in the propensity score-matched pairs. In Korean hypertensive patients without cardiovascular disease, initiation with diuretics could not be superior to other medications, but rather inferior to ARBs in preventing adverse cardiovascular outcomes. Randomized studies are needed to confirm our results.

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Acknowledgements

This study was supported by the Korean Society of Hypertension. The National Health Information Database was provided by the NHIS of Korea.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hack-Lyoung Kim & Doyeon Hwang

  2. Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea

    Jun Hyeok Lee

  3. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Hae-Young Lee

  4. Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Republic of Korea

    Sang-Hyun Ihm

  5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Kwang Il Kim

  6. Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea

    Jinho Shin

  7. Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

    Sungha Park

  8. Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Dae-Hee Kim

  9. Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Ki-Chul Sung

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  1. Hack-Lyoung Kim
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Correspondence to Dae-Hee Kim or Ki-Chul Sung.

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Kim, HL., Hwang, D., Lee, J.H. et al. Diuretics versus others for long-term clinical outcomes as first-line antihypertensive medications: analysis of national real-world database. Hypertens Res 45, 758–768 (2022). https://doi.org/10.1038/s41440-022-00890-8

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