There is some debate as to optimal BP goals with antihypertensive treatment derived mostly in post-hoc analysis of large trials. Because there was limited number of subjects and outcomes within the larger study which may cloud the analytical accuracy of the findings. We suggest a new method to estimate the J-curve.
Felodipine Event Reduction (FEVER) study randomized 9711 Chinese hypertensive patients to more or less intense anti-hypertensive treatment with 159,844 BP measurements. A new approach to evaluate “moving events per 1000 patient observations” (MEPPO) instead of previous methodology, which calculated overall means in fixed intervals. MEPPO was then based on observations from each visit in which event and BP data was collected. Therefore, event data corresponded with BP measured prior to the visits. BP 10 mmHg range to which events were referred and the range was moving with 1 mmHg steps. Each observation to enter 10 times into 10 consecutive 10 mmHg BP ranges. Thus, the overall number of analyzed data is greatly increased.
There is a steep decrease in incidence of all outcomes (all CV events, strokes, cardiac events, CV and all deaths) to reach a rather flat nadir at SBP 129–138 mmHg and DBP 79–88 mmHg. The J-curves in relationship between events and BPs were drown with high precision.
The new approach was more sensitive for J-curve assessment, because all observations were used. The optimal BP goals with antihypertensive treatment are 134 ± 5 (SBP) and 84 ± 5 (SBP) from the FEVER study.
1Biostatistics, Clinical Trials and Research Center, Beijing Hypertension League Institute, China
2Clinical Trials and Research Center, Beijing Hypertension League Institute, China
3Clinical Trials and Research Center, Beijing Hypertension League Institute, China
4Istituto Auxologico Italiano, University of Milan, Italy