|| Checking for direct PDF access through Ovid
In most cases, the 5 first line drugs are recommended for management of hypertension without preference for one or the other. However, it is unclear whether different classes of anti-hypertensive agents have different effect on survival in low risk, uncomplicated hypertension. The aim of this study was to evaluate effects of 4 classes of first line anti-hypertensive agents on improving survival in patients with low risk, uncomplicated hypertension.Adult hypertensive patients without chronic kidney disease, end stage renal disease, diabetes mellitus, acute coronary syndrome, and heart failure in 2002 were selected from Korean National Health Insurance sample cohort consisting of one million subjects. The follow up duration was up to 11 years until 2013. The 5 first line anti-hypertensive agents were categorized into 4 classes; renin angiotensin system blocker (RASB), beta-blocker (BB), calcium channel blocker (CCB), and diuretics. The association between each class of anti-hypertensive agents and mortality was evaluated. Subjects who had prescription data to the anti-hypertensive agents were assumed to be taking the medication.A total 45120 subjects were analyzed and median follow-up duration was 133 months. During follow-up, mortality rate was 17.1% in total subjects, 14.1% in subjects taking RASB, 15.1% in subjects taking BB, 15.6% in subjects taking CCB, and 16.1% in subjects taking diuretics. Kaplan Meier analyses for each class showed a significant difference of mortality (all log-rank p < 0.001). RASB (hazard ratio [HR] = 0.59; 95% confidence interval [CI], 0.56–0.62; p < 0.001), BB (HR = 0.85; 95% CI, 0.81–0.89; p < 0.001), CCB (HR = 0.58; 95% CI, 0.55–0.62; p < 0.001) and diuretics (HR = 0.91; 95% CI, 0.86–0.97; p = 0.002) were significantly associated with lower mortality in multivariate Cox model.The present study demonstrated that all classes of first line antihypertensive drugs significantly reduce mortality in low risk, uncomplicated hypertension. RASB and CCB seem to be more beneficial compared to other classes of antihypertensive agents.