Cor Vasa 2003, 44(11):562-564
Results of the INVEST study in the context of guidelines for the treatment of hypertension
- Oddělení klinické farmakologie, Fakultní nemocnice, Plzeň, Česká republika
It is still unclear whether the protective effect of antihypertensive treatment should be enhanced using more aggressive treatment strategies to achieve target values or, rather, using drugs, which control a broader spectrum of risk factors. Moreover, EUROASPIRE II demonstrated that half of patients with hypertension and coronary heart disease (CHD) are receiving unsatisfactory treatment. The recently published results of the INVEST study showed an equivalent protective effect in high-risk hypertensive patients with overt CHD using two different treatment strategies. The study, enrolling more than 22,000 patients, was designed to determine the number of events including total mortality, non-fatal myocardial infarction and non-fatal stroke (primary endpoint) using treatments based randomly on the calcium channel blocker verapamil SR or the beta-blocker atenolol. Study duration was 2.7 years on average. During 61,807 patients-years, a total of 2,196 events occurred, with 9.62% in the verapamil, and 9.83% in the atenolol arm. Satisfactory control of systolic (< 140 mm Hg) and diastolic blood pressure (< 90 mm Hg) was demonstrated in 65% and 91% of patients, respectively. Both treatments resulted in the same level of blood pressure reduction throughout the study. Also in the ALLHAT study, amlodipine and lisinopril were shown to be equipotent when compared with the diuretic chlorthalidone in terms of protection.
In hypertensives with CHD, verapamil is an effective alternative to beta-blockers, not only in cases where beta-blockers are contraindicated. Results of both INVEST and ALLHAT support the 2003 European and JNC guidelines.
Keywords: Hypertension; High-risk patients; INVEST study; Verapamil; Drug equipotency
Published: November 1, 2003 Show citation