Impact of early or delayed antihypertensive medication on cardiovascular outcomes for newly detected hypertension in general health screenings: A nationwide population-based study in Korea

초록

OBJECTIVE: Hypertension is a significant risk factor for myocardial infarction (MI), stroke, and death. While antihypertensive medication is known to reduce these risks, the optimal timing for initiation remains controversial. This study aims to evaluate and compare the outcome risks associated with early versus delayed antihypertensive treatment in a general health screening setting. METHODS: This study utilized data from 505,212 general health screening examinees without a history of hypertension treatment, MI, and stroke. The population was categorized into normotensive, early treatment (newly diagnosed with hypertension and treated in the same year), and delayed treatment (newly diagnosed but started medication after a year) for hypertension. The risks of MI, stroke, and death were assessed across these groups using Cox proportional hazards models, adjusting for demographic, behavioral, and clinical variables. RESULTS: During the follow-up period (11.34 ± 0.67 years), the incidences of death, MI, and stroke were 6,810 (1.3%), 4,666 (0.9%), and 7,274 (1.4%) subjects, respectively. The hazard ratios (HRs) for MI in the early and delayed treatment groups were 1.52 (1.36-1.69) and 1.56 (1.38-1.76), respectively (p for trend <.0001). For stroke, the HRs were 1.46 (1.35-1.59) in the early treatment group and 1.58 (1.43-1.74) in the delayed treatment group (p for trend <.0001). The risk of death was higher in the delayed treatment group with an HR of 1.79 (1.64-1.97) compared to 1.47 (1.35-1.60) in the early treatment group (p for trend <.0001). CONCLUSIONS: This study provides population-scale evidence from general health screening participants, encouraging the prompt initiation of antihypertensive medication to reduce the risk of adverse outcomes. Delayed consideration of medication in primary health screenings may be associated with higher risks of MI, stroke, and death. © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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