A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients with Coronary Artery Disease the International Verapamil-Trandolapril Study (INVEST): A Randomized Controlled Trial

Carl J. Pepine, Eileen M. Handberg, Rhonda M. Cooper-DeHoff, Ronald G. Marks, Peter Kowey, Franz H. Messerli, Giuseppe Mancia, José L. Cangiano, David Garcia-Barreto, Matyas Keltai, Serap Erdine, Heather A. Bristol, H. Robert Kolb, George L. Bakris, Jerome D. Cohen, William W. Parmley

Research output: Contribution to journalArticle

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Abstract

Context Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. Objective To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non-calcium antagonist strategy (NCAS). Design, Setting, and Participants Randomized, open label, blinded end point study of 22576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. Interventions Patients were randomly assigned to either CAS (verapamil sustained release) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. Main Outcome Measures Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. Results At 24 months, in the CAS group, 6391 patients (81.5%) were taking verapamil sustained release; 4934 (62.9%) were taking trandolapril; and 3430 (43.7%) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5%) were taking atenolol; 4733 (60.3%) were taking hydrochlorothiazide; and 4113 (52.4%) were taking trandolapril. After a follow-up of 61835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93% in CAS and 10.17% in NCAS; relative risk [RR], 0.98; 95% confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0% (systolic) and 88.5% (diastolic) of CAS and 64.0% (systolic) and 88.1% (diastolic) of NCAS patients. A total of 71.7% of CAS and 70.7% of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. Conclusion The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients.

Original languageEnglish
Pages (from-to)2805-2816
Number of pages12
JournalJournal of the American Medical Association
Volume290
Issue number21
DOIs
Publication statusPublished - Dec 3 2003

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trandolapril
Verapamil
Coronary Artery Disease
Randomized Controlled Trials
Hypertension
Calcium
Blood Pressure
Hydrochlorothiazide
Atenolol
Therapeutics
Antihypertensive Agents

ASJC Scopus subject areas

  • Medicine(all)

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A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients with Coronary Artery Disease the International Verapamil-Trandolapril Study (INVEST) : A Randomized Controlled Trial. / Pepine, Carl J.; Handberg, Eileen M.; Cooper-DeHoff, Rhonda M.; Marks, Ronald G.; Kowey, Peter; Messerli, Franz H.; Mancia, Giuseppe; Cangiano, José L.; Garcia-Barreto, David; Keltai, Matyas; Erdine, Serap; Bristol, Heather A.; Kolb, H. Robert; Bakris, George L.; Cohen, Jerome D.; Parmley, William W.

In: Journal of the American Medical Association, Vol. 290, No. 21, 03.12.2003, p. 2805-2816.

Research output: Contribution to journalArticle

Pepine, CJ, Handberg, EM, Cooper-DeHoff, RM, Marks, RG, Kowey, P, Messerli, FH, Mancia, G, Cangiano, JL, Garcia-Barreto, D, Keltai, M, Erdine, S, Bristol, HA, Kolb, HR, Bakris, GL, Cohen, JD & Parmley, WW 2003, 'A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients with Coronary Artery Disease the International Verapamil-Trandolapril Study (INVEST): A Randomized Controlled Trial', Journal of the American Medical Association, vol. 290, no. 21, pp. 2805-2816. https://doi.org/10.1001/jama.290.21.2805
Pepine, Carl J. ; Handberg, Eileen M. ; Cooper-DeHoff, Rhonda M. ; Marks, Ronald G. ; Kowey, Peter ; Messerli, Franz H. ; Mancia, Giuseppe ; Cangiano, José L. ; Garcia-Barreto, David ; Keltai, Matyas ; Erdine, Serap ; Bristol, Heather A. ; Kolb, H. Robert ; Bakris, George L. ; Cohen, Jerome D. ; Parmley, William W. / A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients with Coronary Artery Disease the International Verapamil-Trandolapril Study (INVEST) : A Randomized Controlled Trial. In: Journal of the American Medical Association. 2003 ; Vol. 290, No. 21. pp. 2805-2816.
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abstract = "Context Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. Objective To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non-calcium antagonist strategy (NCAS). Design, Setting, and Participants Randomized, open label, blinded end point study of 22576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. Interventions Patients were randomly assigned to either CAS (verapamil sustained release) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. Main Outcome Measures Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. Results At 24 months, in the CAS group, 6391 patients (81.5{\%}) were taking verapamil sustained release; 4934 (62.9{\%}) were taking trandolapril; and 3430 (43.7{\%}) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5{\%}) were taking atenolol; 4733 (60.3{\%}) were taking hydrochlorothiazide; and 4113 (52.4{\%}) were taking trandolapril. After a follow-up of 61835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93{\%} in CAS and 10.17{\%} in NCAS; relative risk [RR], 0.98; 95{\%} confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0{\%} (systolic) and 88.5{\%} (diastolic) of CAS and 64.0{\%} (systolic) and 88.1{\%} (diastolic) of NCAS patients. A total of 71.7{\%} of CAS and 70.7{\%} of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. Conclusion The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients.",
author = "Pepine, {Carl J.} and Handberg, {Eileen M.} and Cooper-DeHoff, {Rhonda M.} and Marks, {Ronald G.} and Peter Kowey and Messerli, {Franz H.} and Giuseppe Mancia and Cangiano, {Jos{\'e} L.} and David Garcia-Barreto and Matyas Keltai and Serap Erdine and Bristol, {Heather A.} and Kolb, {H. Robert} and Bakris, {George L.} and Cohen, {Jerome D.} and Parmley, {William W.}",
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TY - JOUR

T1 - A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Treatment Strategy for Patients with Coronary Artery Disease the International Verapamil-Trandolapril Study (INVEST)

T2 - A Randomized Controlled Trial

AU - Pepine, Carl J.

AU - Handberg, Eileen M.

AU - Cooper-DeHoff, Rhonda M.

AU - Marks, Ronald G.

AU - Kowey, Peter

AU - Messerli, Franz H.

AU - Mancia, Giuseppe

AU - Cangiano, José L.

AU - Garcia-Barreto, David

AU - Keltai, Matyas

AU - Erdine, Serap

AU - Bristol, Heather A.

AU - Kolb, H. Robert

AU - Bakris, George L.

AU - Cohen, Jerome D.

AU - Parmley, William W.

PY - 2003/12/3

Y1 - 2003/12/3

N2 - Context Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. Objective To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non-calcium antagonist strategy (NCAS). Design, Setting, and Participants Randomized, open label, blinded end point study of 22576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. Interventions Patients were randomly assigned to either CAS (verapamil sustained release) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. Main Outcome Measures Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. Results At 24 months, in the CAS group, 6391 patients (81.5%) were taking verapamil sustained release; 4934 (62.9%) were taking trandolapril; and 3430 (43.7%) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5%) were taking atenolol; 4733 (60.3%) were taking hydrochlorothiazide; and 4113 (52.4%) were taking trandolapril. After a follow-up of 61835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93% in CAS and 10.17% in NCAS; relative risk [RR], 0.98; 95% confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0% (systolic) and 88.5% (diastolic) of CAS and 64.0% (systolic) and 88.1% (diastolic) of NCAS patients. A total of 71.7% of CAS and 70.7% of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. Conclusion The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients.

AB - Context Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. Objective To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non-calcium antagonist strategy (NCAS). Design, Setting, and Participants Randomized, open label, blinded end point study of 22576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. Interventions Patients were randomly assigned to either CAS (verapamil sustained release) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. Main Outcome Measures Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. Results At 24 months, in the CAS group, 6391 patients (81.5%) were taking verapamil sustained release; 4934 (62.9%) were taking trandolapril; and 3430 (43.7%) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5%) were taking atenolol; 4733 (60.3%) were taking hydrochlorothiazide; and 4113 (52.4%) were taking trandolapril. After a follow-up of 61835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93% in CAS and 10.17% in NCAS; relative risk [RR], 0.98; 95% confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0% (systolic) and 88.5% (diastolic) of CAS and 64.0% (systolic) and 88.1% (diastolic) of NCAS patients. A total of 71.7% of CAS and 70.7% of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. Conclusion The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients.

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