According to background information in the article, despite conclusive evidence of the effectiveness of medications to treat high blood pressure in patients with hypertension in general, safety and efficacy of antihypertensive medications in patients with coronary artery disease (CAD) have been discerned only from the analyses of subgroups in large trials.
Carl J. Pepine, M.D., of the University of Florida College of Medicine, Gainesville, Fla., and colleagues designed a randomized trial, the International Verapamil-Trandolapril Study (INVEST), to compare outcomes in older hypertensive patients with CAD treated with a calcium antagonist strategy (CAS; verapamil sustained release [SR]) or a beta-blocker, non-calcium antagonist strategy (NCAS; atenolol). Because most hypertensive patients require more than 1 agent to adequately control blood pressure, INVEST was intended to compare multidrug strategies rather than individual agents. The study included 22,576 hypertensive CAD patients aged 50 years or older, and was conducted September 1997 to February 2003 at 862 sites in 14 countries.
The medications trandolapril and/or hydrochlorothiazide were administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment.
After an average follow-up of 2.7 years per patient, 2,269
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