International Verapamil SR-Trandolapril Study (INVEST trial)

Introduction

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
  • death
  • nonfatal myocardial infarction
  • 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
  • all-cause death
  • myocardial infarction
    • RR=3.71 for BP < 60 mm Hg (relative to BP > 70 mm Hg)
  • but NOT stroke

* low diastolic blood pressure defined as < 70 mm Hg

More general terms

• hypertension clinical trials