Early BP Control Cuts CV-Event Risk in Chinese HTN Patients

Deborah Brauser

June 13, 2016

PARIS, FRANCE — Although studies showing that early blood-pressure control in hypertension improves cardiovascular outcomes have included mostly white patients, new research suggests that the same is also true for Chinese patients [1].

Originally in the Felodipine Event Reduction (FEVER) trial, >10,000 high-risk hypertensive patients at 109 centers in China had received a 6-week run-in with hydrochlorothiazide (HCTZ) followed by randomization to HCTZ felodipine or placebo. Those taking the calcium-channel blocker had significantly fewer strokes (the primary outcome) and reduced CV events and CV mortality.

The new analysis of 9711 FEVER participants showed that those who achieved early BP control 1 to 6 months' postrandomization, regardless of treatment, had significantly fewer CV events and strokes vs those who achieved later BP control. In addition, there were significantly fewer all-cause deaths in those who had BP control within 1 month.

"Despite recent studies' results, it had remained unclear whether early blood-pressure control benefits Chinese patients," lead author Dr Yuqing Zhang (Peking Union Medical College, Beijing, China) told attendees here at the European Society of Hypertension (ESH) 2016 Annual Meeting. However, he noted that the new findings clear up questions for this patient group.

FEVER Subgroups

At enrollment, all FEVER participants were between the ages of 50 and 79 years. Those between 50 and 60 years had to have at least two CV risk factors or a past CV event to be included in the study, whereas older participants had to have at least one risk factor or a past CV event.

For the new analysis, the patients were divided into six groups: those who had controlled or uncontrolled BP at 1 month (n=2968 and 6743, respectively), controlled or uncontrolled BP at 3 months (n=4128 and 5583), and controlled or uncontrolled BP at 6 months (n=4615 and 5096). The investigators defined controlled BP as systolic/diastolic BP <140/90 mm Hg and uncontrolled BP as >140/90 mm Hg.

All of the controlled-BP groups had significantly fewer strokes and composite CV events within 5 years of follow-up than did the uncontrolled groups.

Outcome BP controlled at (mo): HR* 95% CI P
Stroke 1 0.67 0.52–0.86 0.002
3 0.66 0.54–0.82 0.0001
6 0.73 0.60–0.90 0.003
All CV events 1 0.61 0.49–0.75 <0.0001
3 0.70 0.59–0.84 0.0002
6 0.75 0.63–0.90 0.002
*HR=hazard ratio

Patients who had controlled BP at 1 month also had reduced all-cause death vs those with uncontrolled BP (HR 0.55, 95% CI 0.39–0.78; P=0.0007). There were no significant differences in strokes between those with and without controlled BP at 3 or 6 months.

The investigators also conducted a "landmark" analysis of just the participants who had controlled BP at 6 months and did not experience an outcome during that time. These patients were then subdivided into two groups: those who achieved BP control within the first month (n=2078) and those who achieved control up to 6 months (n=2358).

Significantly fewer members of the earlier group had CVD events within 5 years vs the latter group (HR 0.65, 95% CI 0.47–0.01; P=0.01), and there were fewer occurrences of all-cause death (HR 0.49, 95% CI 0.29–0.83; P=0.008). Although there were also trends toward fewer CV deaths and strokes, they were not significantly different between the groups.

"Blood-pressure control within a certain period of time . . . may be a key determinant to the reduction of cardiovascular disease, which reinforces the concept of early control being necessary in the management of hypertension in Chinese patients," said Zhang.

After the talk, session moderator Dr Eivind Berge (Oslo University Hospital, Norway) called the presentation "very interesting, with interesting results." Later, he told heartwire from Medscape that the findings "were pretty clear" that early BP control conveyed significant benefit over later control.

However, Berge noted that he looks forward to seeing more detailed data from the study soon.

Zhang and Berge reported no relevant financial disclosures.

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