Published online before print July 2, 2007, doi: 10.1161/HYPERTENSIONAHA.107.092114
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(Hypertension. 2007;50:287.)
© 2007 American Heart Association, Inc.
Editorial Commentaries |
Hypertension Treatment
How Important Is Consistency of Effect?
From the Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University Health System, Richmond.
Correspondence to Domenic A. Sica, Box 980160 MCV Station, Richmond, VA 23298-0160. E-mail DSICA@HSC.VCU.EDU
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
There has been a steady stream of large outcomes trials in the last 20 years that have attempted to answer important questions in cardiovascular disease with the INternational VErapamil SR-Trandolapril (INVEST) Study being one such trial.1 The original intent of the INVEST Study was to compare mortality and morbidity outcomes in patients with hypertension and coronary artery disease treated with a calcium channel blocker (CCB)–based strategy versus a ß-blocker-based strategy. The premise behind this study was a rather simple one, and at the end of the day, this study showed that a verapamil-based regimen (CCB strategy) and an atenolol-based regimen (ß-blocker strategy) similarly reduced the primary composite end point of all-cause mortality, nonfatal myocardial infarction, or nonfatal stroke.1
Outcome trials are often monumental undertakings with the perception of end-of-study results ranging from the common "so what" to a less frequent "that’s an important finding." In these trials, the sense of indifference to neutral (or negative) findings typically endures unless secondary or posthoc analyses provide additional helpful information. Even then, many remain nonplussed with the statistical acrobatics needed to show one treatment to somehow be more meaningful than another.
How do these issues then relate to the INVEST trial, where the findings were primarily neutral ones?1 Shortly after its original publication, a series of posthoc analyses was undertaken with the INVEST data set to supplement the original findings. These analyses showed the following: (1) the use of verapamil SR and trandolapril in this coronary artery disease population reduced the risk of
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Hypertension 2007 50: 299-305.