Verapamil-sustained release–based treatment strategy is equivalent to atenolol-based treatment strategy at reducing cardiovascular events in patients with prior myocardial infarction: An INternational VErapamil SR-Trandolapril (INVEST) substudy - 09/08/11
, Jerome D. Cohen, MD b, Peter H. Bacher, MD, PhD c, Peter Sleight, MD d, Giuseppe Mancia, MD, PhD e, Peter Kowey, MD f, Qian Zhou, PhD c, Annette Champion, MBA c, Carl J. Pepine, MD gfor the INVEST Investigators
Résumé |
Background |
In patients with prior myocardial infarction (MI), β-blockers reduce mortality by 23% to 40%. However, despite this favorable effect, adverse effects limit compliance to this medication. The purpose of the study was to compare a β-blocker–based strategy with a heart rate–lowering calcium antagonists–based strategy in patients with prior MI.
Methods |
We evaluated 7,218 patients with prior MI enrolled in the INternational VErapamil SR-Trandolapril (INVEST) substudy randomized to verapamil-sustained release (SR)– or atenolol-based strategies. Primary outcome was time to first occurrence of death (all-cause), nonfatal MI, or nonfatal stroke. Secondary outcomes included death, total MI (fatal and nonfatal), and total stroke (fatal and nonfatal) considered separately.
Results |
During the 2.8 ± 1.0 years of follow-up, patients assigned to the verapamil-SR–based and atenolol-based strategies had comparable blood pressure control, and the incidence of the primary outcome was equivalent. There was no difference between the 2 strategies for the outcomes of either death or total MI. However, more patients reported excellent/good well-being (82.3% vs 78.0%, P = .02) at 24 months with a trend toward less incidence of angina pectoris (12.0% vs 14.3%, adjusted P = .07), nonfatal stroke (1.4% vs 2.0%; P = .06), and total stroke (2.0% vs 2.5%, P = .18) in the verapamil-SR–based strategy group.
Conclusions |
In hypertensive patients with prior MI, a verapamil-SR–based strategy was equivalent to a β-blocker–based strategy for blood pressure control and prevention of cardiovascular events, with greater subjective feeling of well-being and a trend toward lower incidence of angina pectoris and stroke in the verapamil-SR–based group.
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| This work was presented in part at the 2007 Annual Scientific Session of the American College of Cardiology in New Orleans, LA, on March 26, 2007. |
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| This study was supported by grants from the University of Florida (Gainesville, FL) and Abbott Laboratories (Abbott Park, IL). |
Vol 156 - N° 2
P. 241-247 - août 2008 Retour au numéro
Article précédent
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