Evaluation of transitions from early hypertension to hypertensive chronic kidney disease, coronary artery disease, stroke and mortality: A Thai real-world data cohort
1 Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2 Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3 Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
4 School of Medicine and Public Health, University of Newcastle, Australia
5 Hunter Medical Research Institute, Newcastle, Australia
Abstract
Objective: Systemic arterial hypertension is a major modifiable risk factor for cardiovascular disease and all-cause death. Understanding its progression from early state to late complications should lead to more timely intensification of treatment. This study aimed to construct a real-world cohort profile of hypertension and estimate transition probabilities from the uncomplicated state to chronic kidney disease (CKD), coronary artery disease (CAD), stroke, and all-cause death (ACD).
Methods: This real-world cohort study used routine clinical practice data for all adult patients diagnosed with hypertension at Ramathibodi Hospital, Thailand, from 2010 to 2022. A multi-state model was developed with five states: uncomplicated hypertension, CKD, CAD, stroke, and ACD. Transition probabilities were estimated using the Kaplan-Meier method.
Results: A total of 144,149 patients were initially classified as having uncomplicated hypertension. The 10-year transition probabilities from the initial state to CKD, CAD, stroke, and ACD were 19.6%, 18.2%, 7.4%, and 1.7%, respectively. Once in intermediate states, 10-year transition probabilities to death were 7.5% (from CKD), 9.0% (from CAD), and 10.8% (from stroke).
Conclusions: In this 13-year cohort, CKD was the most common complication, followed by CAD and stroke. Among these, stroke carried the highest risk of all-cause death, followed by CAD and CKD. These findings provide improved understanding of disease progression to guide appropriate prevention measures.
