Dual therapy in hypertensive patients with coronary artery disease: the role of calcium channel blockers and beta-blockers.

Abstract

BACKGROUND:

The majority of hypertensive patients require combination therapy to achieve BP goals. Guidelines recommend dual therapy in newly diagnosed patients with BP > 160/100mm Hg. Calcium channel blocker (CCB)/ACE inhibitor and beta-blocker (beta-adrenoceptor antagonists)/diuretic combinations are among regimens considered effective for BP control. ACE inhibitors, beta-blockers, and CCBs are recommended for use in patients after myocardial infarction (MI). Statistical modeling from INVEST (INternational VErapamil-Trandolapril STudy), suggests an association between dual and triple therapy and decreased risk of primary outcome ([PO] first occurrence of death, nonfatal MI, or nonfatal stroke) in patients with hypertension and coronary artery disease (CAD).

OBJECTIVE AND METHODS:

This study explores the utility of dual antihypertensive therapy by reporting BP and cardiovascular outcomes for INVEST patients who predominantly received either a CCB/ACE inhibitor or a beta-blocker/ diuretic regimen.

RESULTS:

1170 patients were selected for analysis. After 24 months of treatment, BP control (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VI criteria) was 82.1% and 82.6% in the verapamil sustained release (SR) + trandolapril (Ve + Tr) and atenolol + hydrochlorothiazide (At + HCTZ) groups, respectively (p = 0.86). In Ve + Tr compared to At + HCTZ patients, adjusted risk for PO (hazard ratio [HR] 0.63; 95% CI 0.37, 1.05; p = 0.07) and unadjusted risks for secondary outcomes including death (HR 0.70; 95% CI 0.40, 1.25), total MI (HR 0.82; 95% CI 0.35, 1.90), total stroke (HR 0.81; 95% CI 0.25, 2.65) and new diabetes (HR 0.88; 95% CI 0.55, 1.41) were not statistically different.

CONCLUSION:

This analysis shows that combination treatment with either Ve+ Tr or At +- HCTZ is effective in achieving BP control and produces similar outcomes in hypertensive patients with CAD.

• Authors: George L Bakris, Rhonda M Cooper-Dehoff, Qian Zhou, Stuart Kupfer, Annette Champion, Carl J Pepine, INVEST Investigators
• Journal: American journal of cardiovascular drugs : drugs, devices, and other interventions (Am J Cardiovasc Drugs) Vol. 7 Suppl 1 Pg. 25-9 ( 2007) ISSN: 1175-3277 [Print] New Zealand
• PMID: 19845074 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents
• Calcium Channel Blockers
• Diuretics
• Indoles
• Hydrochlorothiazide
• trandolapril
• Atenolol
• Verapamil

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Analysis of Variance
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Atenolol (therapeutic use)
• Blood Pressure (drug effects)
• Calcium Channel Blockers (therapeutic use)
• Coronary Artery Disease (complications)
• Diuretics (therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Hydrochlorothiazide (therapeutic use)
• Hypertension (complications, drug therapy)
• Indoles (therapeutic use)
• Male
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Treatment Outcome
• Verapamil (therapeutic use)