The Felodipine Event Reduction (FEVER) Study: a randomized long-term placebo-controlled trial in Chinese hypertensive patients

Abstract

In moderately complicated hypertensive patients from China even a difference in SBP/DBP as small as 4/2 mmHg, such as that induced by adding low-dose felodipine to low-dose hydrochlorothiazide, is associated with very substantial reductions in the incidence of most types of cardiovascular events. As the SBP achieved in the felodipine group was below the recommended goal of less than 140 mmHg, and SBP in the placebo group was slightly above that level, FEVER provides the required evidence in support of the guidelines recommended goal, even for a hypertensive population not entirely consisting of patients with diabetes or previous cardiovascular events.

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

“…Of note, this patient population had a higher rate of prior stroke/transient ischemic attack (TIA), suggesting higher baseline risk for CVD; that is despite the fact that other baseline characteristics such as diabetes, previous MI, and incidence of cardiovascular events were in a similar range to those of other large studies 16. Unlike JATOS, FEVER did not meet the JNC 8 committee's criteria for inclusion in their deliberations 1…”

“…Fatal and nonfatal stroke was reduced by 27% in the intensive treatment group ( P =0.001), while cardiac events and all‐cause mortality were lowered by 35% ( P =0.012) and 31% ( P =0.006), respectively 16. The average age of the FEVER patients was 62 years; thus, according to the JNC 8 recommendations, the majority of these patients would not receive additional therapy to achieve SBP ≤140 mm Hg.…”

Use of dihydropyridine calcium channel blockers in the management of hypertension in Eastern Asians: A scientific statement from the Asian Pacific Heart Association

“…[1][2][3][4][5] Indeed, nitrendipine was used in the Syst-China (Systolic Hypertension in China trial), 1,2 nifedipine in the Shanghai trial 3 and felodipine in the FEVER (Felodipine Event Reduction) trial. 4 Despite the fact that these CCBs are short or intermediate acting, active antihypertensive treatment significantly reduced the risk of fatal and non-fatal strokes, the major complication of hypertension in the Chinese population, by 38, 58 and 27% in the Syst-China, 1 Shanghai 3 and FEVER trials, 4 respectively.…”

“…In the recent Chinese FEVER trial, the incidence of stroke and coronary events was 15.9 and 6.2 per 1000 patientyears, respectively. 4 Third, dihydropyridine CCBs are particularly useful in the prevention and amelioration of coronary spasm, which is more prevalent in Japanese patients than in Europeans. 9,10 Indeed, the incidence of coronary spasm after acetylcholine injection was 47 and 15% of arteries, respectively, in 15 Japanese and 19 European patients within 14 days of an acute myocardial infarction (Po0.0001).…”

Review: Angiotensin-converting enzyme inhibitors and coronary heart disease prevention

“…For example, in the recent Felodipine EVEnt Reduction (FEVER) trial, add-on therapy with a low dose of felodipine produced a sustained reduction in BP of only 4/2 mmHg but this was sufficient to provide clinically important reductions in various CV outcomes, including a 35% reduction in all cardiac events. 24 …”