A verapamil-SR strategy resulted in similar rates of death, non-fatal MI, or non-fatal stroke compared to an atenolol strategy (9.67% vs 9.88%; P=0.62), despite less resting heart rate reduction.
RCT
Yes
Does a verapamil-SR-based strategy compared to an atenolol-based strategy reduce adverse outcomes in hypertensive patients with coronary artery disease?
In hypertensive patients with coronary artery disease, resting heart rate predicts adverse outcomes, but achieving a lower resting heart rate with an atenolol-based strategy versus a verapamil-SR-based strategy does not further reduce adverse clinical events.
Absolute Event Rate: 9.67% vs 9.88%
p-value: p=0.62
AIM: To determine the relationship between resting heart rate (RHR) and adverse outcomes in coronary artery disease (CAD) patients treated for hypertension with different RHR-lowering strategies. METHODS AND RESULTS: Time to adverse outcomes (death, non-fatal myocardial infarction, or non-fatal-stroke) and predictive values of baseline and follow-up RHR were assessed in INternational VErapamil-SR/trandolapril STudy (INVEST) patients randomized to either a verapamil-SR (Ve) or atenolol (At)-based strategy. Higher baseline and follow-up RHR were associated with increased adverse outcome risks, with a linear relationship for baseline RHR and J-shaped relationship for follow-up RHR. Although follow-up RHR was independently associated with adverse outcomes, it added less excess risk than baseline conditions such as heart failure and diabetes. The At strategy reduced RHR more than Ve (at 24 months, 69.2 vs. 72.8 beats/min; P < 0.001), yet adverse outcomes were similar Ve 9.67% (rate 35/1000 patient-years) vs. At 9.88% (rate 36/1000 patient-years, confidence interval 0.90-1.06, P = 0.62). For the same RHR, men had a higher risk than women. CONCLUSION: Among CAD patients with hypertension, RHR predicts adverse outcomes, and on-treatment RHR is more predictive than baseline RHR. A Ve strategy is less effective than an At strategy for lowering RHR but has a similar effect on adverse outcomes.
“Now there's an alternative to what's considered the standard of care. The big problem with hypertension is treatment and compliance with treatment. Surveys show that perhaps only 30 percent or less of the patients in the United States who are known to be hypertensive are on treatment and even a smaller percentage are at blood pressure goal for their treatment. It is believed that an important reason for that is the inability to tolerate the treatments. So here we have an alternative treatment strategy that appears to be just as good in terms of preventing adverse outcomes and maybe even better in terms of preventing the emergence of new diabetes cases.”
Kolloch et al. (Fri,) conducted a rct in Hypertension with coronary artery disease. Verapamil-SR-based strategy vs. Atenolol-based strategy was evaluated on Death, non-fatal myocardial infarction, or non-fatal stroke (95% CI 0.90-1.06, p=0.62). A verapamil-SR strategy resulted in similar rates of death, non-fatal MI, or non-fatal stroke compared to an atenolol strategy (9.67% vs 9.88%; P=0.62), despite less resting heart rate reduction.