Published Online
on September 20, 2004

A more recent version of this article appeared on November 1, 2004

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Submitted on June 19, 2004
Revised on July 8, 2004

Clinical Outcomes in the Diabetes Cohort of the International Verapamil SR-Trandolapril Study

George L. Bakris^*; Efrain Gaxiola; Franz H. Messerli; Giuseppe Mancia; Serap Erdine; Rhonda Cooper-DeHoff; Carl J. Pepine;; for the INVEST Investigators

From the Rush University Medical Center (G.L.B.), Chicago, Ill; Instituto Cardiovascular de Guadalajara (E.G.), Guadalajara, Mexico; Ochsner Clinic (F.H.M.), New Orleans, La; Clinica Medica and Centro Interuniversitario di Fisiologia Clinica e Ipertensione (G.M.), Università degli Studi Milano-Bicocca, Milan, Italy; Cardiology Institute (S.E.), University of Istanbul, Istanbul, Turkey; and University of Florida (R.C-D., C.J.P.), Gainesville, Fla.

^* To whom correspondence should be addressed. E-mail: George_Bakris{at}rush.edu.

Abstract--The INternational VErapamil SR-Trandolapril study (INVEST) had 6400 of 22 576 (28.3%) participants with diabetes at entry. The objectives of this prespecified analysis were to compare antihypertensive treatment strategies in the diabetes cohort (verapamil SR-based [n=3169] versus atenolol-based [n=3231]) and identify predictors for the primary outcome (a composite of first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke). During a mean follow-up of 2.7 years, 913 participants with diabetes experienced a primary outcome event, with no significant difference between treatment strategies (14.6%, verapamil SR versus 13.9%; atenolol hazard ratio, 1.05; 95% confidence interval, 0.92 to 1.19). Risk for the primary outcome increased with presence of baseline heart failure, renal impairment, US residency, age, previous stroke/transient ischemic attack, previous myocardial infarction, peripheral vascular disease, or smoking. High systolic and diastolic pressures during follow-up also were associated with increased risk, as were low diastolic pressures. Antihypertensive treatment with a verapamil SR or atenolol strategy resulted in similar rates of cardiovascular outcomes in coronary artery disease (CAD) patients with diabetes. Thus, a verapamil SR-based antihypertensive treatment strategy is an alternative to a -blocker-based strategy in adults with CAD and diabetes.

Key words: blood pressure • diabetes mellitus • coronary artery disease • calcium antagonists

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