Authors: Bakris, George L.; Cooper-DeHoff, Rhonda M.; Zhou, Qian; Kupfer, Stuart; Champion, Annette; Pepine, Carl J.

Source: American Journal of Cardiovascular Drugs, Volume 7, Supplement 1, 2007 , pp. 25-29(5)

Publisher: Adis International

Abstract:

Background: The majority of hypertensive patients require combination therapy to achieve BP goals. Guidelines recommend dual therapy in newly diagnosed patients with BP >160/100mm Hg. Calcium channel blocker (CCB)/ACE inhibitor and β-blocker (β-adrenoceptor antagonists)/diuretic combinations are among regimens considered effective for BP control. ACE inhibitors, β-blockers, and CCBs are recommended for use in patients after myocardial infarction (MI). Statistical modeling from INVEST (INternational VErapamil-Trandolapril STudy), suggests an association between dual and triple therapy and decreased risk of primary outcome ([PO] first occurrence of death, nonfatal MI, or nonfatal stroke) in patients with hypertension and coronary artery disease (CAD).

Objective and Methods: This study explores the utility of dual antihypertensive therapy by reporting BP and cardiovascular outcomes for INVEST patients who predominantly received either a CCB/ACE inhibitor or a β-blocker/diuretic regimen.

Results: 1170 patients were selected for analysis. After 24 months of treatment, BP control (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VI criteria) was 82.1% and 82.6% in the verapamil sustained release (SR) + trandolapril (Ve + Tr) and atenolol + hydrochlorothiazide (At + HCTZ) groups, respectively (p = 0.86). In Ve + Tr compared to At + HCTZ patients, adjusted risk for PO (hazard ratio [HR] 0.63; 95% CI 0.37, 1.05; p = 0.07) and unadjusted risks for secondary outcomes including death (HR 0.70; 95% CI 0.40, 1.25), total MI (HR 0.82; 95% CI 0.35, 1.90), total stroke (HR 0.81; 95% CI 0.25, 2.65) and new diabetes (HR 0.88; 95% CI 0.55, 1.41) were not statistically different.

Conclusion: This analysis shows that combination treatment with either Ve + Tr or At + HCTZ is effective in achieving BP control and produces similar outcomes in hypertensive patients with CAD.

Document Type: Miscellaneous

Publication date: 2007-01-01

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• In this Subject: Cardiovascular Medicine ,  Pharmacology
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