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

Bangalore, Sripal; Messerli, Franz H.; Cohen, Jerome D.; Bacher, Peter H.; Sleight, Peter; Mancia, Giuseppe; Kowey, Peter; Zhou, Qian; Champion, Annette; Pepine, Carl J.; for the INVEST Investigators,

doi:10.1016/j.ahj.2008.02.023

« Previous Next »American Heart Journal
Volume 156, Issue 2 , Pages 241-247, August 2008

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

Sripal Bangalore, MD, MHA
- Division of Cardiovascular Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY
Franz H. Messerli, MD
- Division of Cardiovascular Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY
- Reprint requests: Franz H. Messerli, MD, Hypertension Program, Division of Cardiology, Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, 1000 Tenth Avenue, Suite 3B-30, New York, NY 10025.
Jerome D. Cohen, MD
- Department of Medicine, Saint Louis University, St Louis, MO
Peter H. Bacher, MD, PhD
- Abbott Laboratories, Abbott Park, Chicago, IL
Peter Sleight, MD
- Department of Medicine, Lankenau Hospital, Wynnewood, PA
Giuseppe Mancia, MD, PhD
- Department of Medicine, Universita Degli Studi, Monza, Italy
Peter Kowey, MD
- Main Line Health Heart Center, Wynnewood, Philadelphia, PA
Qian Zhou, PhD
- Abbott Laboratories, Abbott Park, Chicago, IL
Annette Champion, MBA
- Abbott Laboratories, Abbott Park, Chicago, IL
Carl J. Pepine, MD
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL
for the INVEST Investigators

Received 16 November 2007; accepted 25 February 2008.

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.