Systolic BP below 140 mmHg benefits uncomplicated hypertensives
MedWire News: Results from the FEVER study indicate that a target systolic blood pressure (BP) of less than 140 mmHg, as recommended by the European Society of Cardiology (ESC), improves the outcomes of all hypertensive patients, including those with a very low risk for adverse cardiovascular (CV) events.
The study findings, say Alberto Zanchetti (University of Milan, Italy) and team, therefore suggest that "the often reported opinion that the benefit of antihypertensive therapy is proportionally greater in high-risk patients" may not be accurate.
The FEVER study, published in the European Heart Journal, involved 9711 hypertensive Chinese patients aged 50-79 years, with one or more additional CV risk factors (eg, diabetes and smoking) or a history of CV disease.
All patients had a systolic BP of 140-180 and a diastolic BP of 90-110 mmHg at baseline (6 weeks after stopping prestudy antihypertensive medication) and were randomly allocated to receive intense therapy (thiazide diuretic plus a calcium channel blocker) or less-intense therapy (thiazide plus placebo).
Zanchetti and team report that after a follow-up period of 40 months, both treatment groups experienced a significant reduction in mean BP, at 17/9 and 12/6 mmHg among patients receiving intense and less-intense treatment, respectively.
By the end of the study, patients in the intense treatment group (mean systolic BP 138 mmHg) achieved the ESC recommended, while those in the less-intense treatment group (mean systolic BP 142 mmHg) fell slightly short of the target.
When patients were grouped according to risk for CV events, the team found that uncomplicated (no history of diabetes or CV disease) and elderly hypertensives (mean age 69.5 years), and patients with moderately elevated systolic BP (<153 mmHg) all experienced significant respective reductions of 1.6, 3.8, and 1.1 strokes per 100 patients by the end of the follow-up period.
Furthermore, the rate of CV events, including stroke and myocardial infarction, also fell among all patient groups, with reductions of 2.1, 5.2, and 1.6 CV events per 100 patients in uncomplicated and elderly hypertensives, and patients with moderately elevated systolic BP levels, respectively, after 40 months.
A similar trend was noted for CV and all-cause death rates.
Zanchetti et al conclude: "The size of benefit [of systolic BP reduction] is greater in the elderly than in the low-to-intermediate risk uncomplicated hypertensives, but even in the latter group, it appears to justify the small and modestly expensive increment of drug therapy required in FEVER to achieve goal systolic BP."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor