Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study

We studied the profiles of all-cause and cardiovascular (CVS) mortality among users of different antihypertensive classes in a Chinese population. From electronic patient records, a cohort study was conducted among 18,338 patients who ever newly prescribed an alpha-blocker, thiazide diuretic, beta-blocker, calcium channel blocker (CCB) or agents acting on the renin-angiotensin system (RAS) without drug discontinuation or switching in the public primary-care sector in a large Territory of Hong Kong during January 2004-June 2007. The odds ratios of mortality (all-cause and CVS) were evaluated according to the prescribed antihypertensive drug classes by Cox proportional hazards regression analyses. A total of 823 deaths (4.5%) were reported during the study period. The crude proportions of all-cause mortality were highest in alpha-blockers (6.2%) and CCB (5.7%), but lowest in beta-blockers (2.8%). Compared with CCB, patients on thiazide diuretics were shown to have statistically significantly lower all-cause (adjusted hazard ratios (aHRs) 0.75, 95% CI 0.60, 0.93, P=0.010) and CVS mortality (aHR 0.40, 95% CI 0.21, 0.78, P=0.007), but the 95% CI of the odds ratios of the major drug classes overlapped. When each drug class was used as a reference group, or when patients with only uncomplicated hypertension were included, their respective 95% CI similarly overlapped. Antihypertensive drug classes were associated with statistically comparable odds of all-cause and CVS mortality. This finding from real-life clinical practice further supports the position statements from international guidelines, which recommend that the major antihypertensive drug classes are suitable for initiating pharmacotherapy for the management of hypertension

Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO

OBJECTIVE: To evaluate the extent to which stillbirths affect international comparisons of preterm birth rates in low- and middle-income countries. DESIGN: Secondary analysis of a multi-country cross-sectional study. SETTING: 29 countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. POPULATION: 258 215 singleton deliveries in 286 hospitals. METHODS: We describe how inclusion or exclusion of stillbirth affect rates of preterm births in 29 countries. MAIN OUTCOME MEASURES: Preterm delivery. RESULTS: In all countries, preterm birth rates were substantially lower when based on live births only, than when based on total births. However, the increase in preterm birth rates with inclusion of stillbirths was substantially higher in low Human Development Index (HDI) countries [median 18.2%, interquartile range (17.2-34.6%)] compared with medium (4.3%, 3.0-6.7%), and high-HDI countries (4.8%, 4.4-5.5%). CONCLUSION: Inclusion of stillbirths leads to higher estimates of preterm birth rate in all countries, with a disproportionately large effect in low-HDI countries. Preterm birth rates based on live births alone do not accurately reflect international disparities in perinatal health; thus improved registration and reporting of stillbirths are necessary. TWEETABLE ABSTRACT: Inclusion of stillbirths increases preterm birth rates estimates, especially in low-HDI countries

Impact of stillbirths on international comparisons of preterm birth rates: a secondary analysis of the WHO multi-country survey of Maternal and Newborn Health

10.1111/1471-0528.14548BJOG: An International Journal of Obstetrics and Gynaecology12491346-135