Hypertension and Incidence of Mortality in General Population of a Mediterranean Region

Abstract

Objective: Hypertension is the most relevant risk factor of mortality over the world. Assessment of the impact has been analysed in a great variety of studies, but the Electronic Health Recordings, including hole populations, provide a more precise information. The objective was to assess the mortality associated to adult hypertensive patients from a Mediterranean population. The associated impact of diabetes (DM) and chronic kidney disease (CKD) has been presented. Design and method: The sample was recruited from beneficiaries of the Valencian Health Agency's health care system, with a population of 3799884 people older than 25 years in 2012. The observational study was undertaken as part of routine clinical practice from 2012 until 2016. Hypertension was defined by a recorded physician diagnosis or antihypertensive medication use. Diabetes was defined as a non-fasting glucose higher or equal to 200 mg/dl, a recorded physician diagnosis, medication use or an HbA1c higher or equal to 6.5%. Estimated glomerular filtration rate (eGFR) was calculated from calibrated creatinine, age and sex using the CKD-EPI and CKD was defined when eGFR <60 ml/min/1.73m2. Participants were followed for all-cause mortality until 31st December 2016. Vital status was determined by matching records and death certificates from the Spanish National Death Index. Results: Among the total population, 1247467 hypertensives were included. Among them, 387590 (%) were diabetics and 272800 (%) CKD. A total de 204629 casualties were recorded (crude rate of 2.2% in the GP and 12% in HTN, 16% in DM and 23% in CKD. Mortality incidence per 10000 patients/year of general population and the hypertensives, in each decade of age and by sex, with and without diabetes and CKD are in the Table. Conclusions: The increment of mortality risk due to the presence of HTN increases in all age groups. Although the higher increment in risk occurs in population beyond 60 yr, the number of subjects in risk largely increases over 60 and extent until the ninety decade. Diabetes, and more CKD, further increases the risk in hypertensive subjects.