Effects of individual risk factors on the residual risk of cardiovascular events
in a population of treated Chinese patients with hypertension: data from the
Felodipine Event Reduction (FEVER) study.
Author(s): Zhang Y, Zhang X, Liu L, Zanchetti A; FEVER Study Group.
Affiliation(s): Division of Hypertension, FuWai Hospital and Cardiovascular Institute, Chinese
Academy of Medical Sciences, Beijing, China.
Publication date & source: 2010, J Hypertens. , 28(10):2016-25
BACKGROUND AND OBJECTIVES: The added cardiovascular risk conferred by risk
factors or diseases accompanying hypertension has been investigated in Caucasian
patients, and much less is known in Chinese patients. Furthermore, the residual
risk persisting in hypertensive patients, despite blood pressure (BP) reduction,
due to accompanying conditions has never been explored in Chinese, and whether
they differ from Caucasians under this respect is unknown.
METHODS: Felodipine Event Reduction (FEVER) study randomized 9711 Chinese
hypertensive patients to more or less intense antihypertensive treatment for 40
months, with outcome monitoring. The present analyses provide information on the
role that baseline presence of individual risk factors has in increasing outcome
probability despite BP control. Risk ratios were calculated using Cox
proportional hazard models, adjusted for a large number of baseline variables,
except the one under examination, and also adjusted for on-treatment systolic and
diastolic BP.
RESULTS: Male sex, older age, diabetes and cardiovascular disease were
accompanied by a significantly higher incidence of cardiovascular events (risk
ratios 1.41-1.86 according to risk factor), stroke (risk ratios 1.42-1.72),
cardiac events (risk ratios 1.40-2.70), all-cause death (risk ratios 1.51-2.16)
and cardiovascular death (risk ratios 1.61-2.02). Higher baseline systolic BP and
smoking conferred a significantly increased risk of cardiovascular events and
strokes. Higher cholesterol was not found to increase any cardiovascular outcome.
The same was the case for electrocardiographic left-ventricular hypertrophy and
isolated systolic hypertension.
CONCLUSIONS: A number of additional risk factors increased the residual risk of
Chinese hypertensive patients despite effective antihypertensive treatment as
much as described in Caucasians. High serum cholesterol was an exception: whether
this is a Chinese characteristic or a more general phenomenon remains to be
investigated.
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