Verapamil- and atenolol-based strategies are equally effective in black patients with hypertension and coronary artery disease: A subanalysis of the international verapamil SR-trandolapril study (INVEST)

This INVEST subanalysis investigated the antihypertensive and cardiovascular effects of verapamil SR (Ve) or atenolol (At) strategies in Black patients with hypertension (HTN) and coronary artery disease (CAD). INVEST randomized 22,576 HTN CAD patients to a Ve- or At-based strategy. Dose titration and additional of trandolapril and/or HCTZ were recommended to achieve JNC VI BP targets. Overall incidence of the primary outcome (death, nonfatal MI, or nonfatal stroke [PO]) was equivalent between strategies. Black patients comprised 13% of the study and had a PO rate of 11.6% in both strategies (HR = 0.99; 95% CI 0.80, 1.22), compared to a PO rate of 12.1% for Caucasian patients in both strategies. Baseline characteristics, rates of death, nonfatal MI, nonfatal stroke and BP control were similar for Black patients in the two strategies, except that 24 month BP control (<140/90 mmHg) was significantly better in the Ve group (table). Greater than 60% of Black patients received 3 or more antihypertension drugs at month 24. INVEST Black Patients # p-values from one-way ANOVA for continuous variables, chi-square test for categorical variables, log- rank test for outcomes In conclusion, verapamil- and atenolol-based multidrug strategies are equally effective in Black patients with hypertension and CAD when BP control, cardiovascular morbidity and mortality endpoints are considered.