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(Hypertension. 2004;44:614.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Importance of Achieving Lower Blood Pressure in Hypertensive Patients With Diabetes

From the University of Missouri–Columbia.

Correspondence to James R. Sowers, MD, University of Missouri-Columbia, Department of Internal Medicine, Health Science Center, MA410, Columbia, MO 65212. E-mail Sowersj@health.missouri.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The The INternational VErapamil SR-trandolapril STudy (INVEST), a prospective open trial with blinded end point design, included 6400 participants with diabetes, coronary artery disease, and hypertension among a total of 22 576 participants.¹ The trial was designed to compare a nondihydropyridine calcium antagonist verapamil SR-based and atenolol-based antihypertensive regimen. The protocol provided for an option of adding an angiotensin-converting enzyme (ACE) inhibitor, trandolapril or hydrochlorothiazide, to achieve blood pressure targets from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), less than130/85 mm Hg in the cohort with diabetes. Diabetes was defined as anyone with a history of diabetes mellitus or use of an oral hypoglycemic agent or insulin at baseline. Mean follow-up was 2.7 years in the diabetic group. The diabetic group had almost twice the risk for cardiovascular disease (CVD) events compared with those without diabetes in INVEST.

The primary outcome (composite of first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke) was not different between treatment strategies. Thus, this is the first outcome study to demonstrate a similar CVD outcome benefit between ß-blocker and nondihydropyridine-based blood pressure treatment strategies in diabetic patients with coronary artery disease. Further, on-treatment analysis showed a trend for reduced primary outcomes with the addition of trandolaril to verapamil SR or hydrochlorothiazide to atenolol (combination therapy). These results are similar to those observed in the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) trial,² where the primary outcome of the . . . [Full Text of this Article]