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International Verapamil SR-Trandolapril Study (INVEST trial)
Study characteristics:
- 22,576 participants, with hypertension & CAD
- observational subgroup analysis of 6400 participants
- participants were at least 50 years old & had diabetes & coronary artery disease
- conducted from September 1997 to February 2003
- 862 sites in 14 countries
- randomized trial
Treatment:
- verapamil sustained-release or atenolol followed by an ACE inhibitor, a diuretic, or both to achieve systolic BP < 130 mm Hg & diastolic BP < 85 mm Hg
- tight control: systolic BP < 130 mm Hg
- usual control: 130-140 mm Hg
- uncontrolled: > 140 mm Hg
Endpoint:
- adverse cardiovascular outcomes, including
a) death
b) nonfatal myocardial infarction
c) nonfatal stroke
Results:
- 16,893 patient-years of follow-up, endpoint reached in:
- 12.7% who maintained tight control
- 12.6% who had usual control
- 19.8% with uncontrolled systolic BP
- blood pressure control & outcomes were equivalent
- low diastolic BP* was associated increased risk for
a) all-cause death
b) myocardial infarction
- RR=3.71 for BP < 60 mm Hg (relative to BP > 70 mm Hg)
c) but NOT stroke
* low diastolic blood pressure defined as < 70 mm Hg
General
hypertension clinical trials
References
- Cooper-DeHoff RM et al
Tight Blood Pressure Control and Cardiovascular Outcomes
Among Hypertensive Patients With Diabetes and Coronary Artery
Disease.
JAMA. 2010;304(1):61-68.
PMID: 20606150
http://jama.ama-assn.org/cgi/content/short/304/1/61
- Hochman JS et al,
Early revascularization and long-term survival in cardiogenic
shock complicating myocardial infarction.
JAMA 2006; 295:2511
PMID: 16757723