Clinical outcomes in the diabetes cohort of the international verapamil SR-Trandolapril study
Clinical outcomes in the diabetes cohort of the international verapamil SR-Trandolapril study
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DOI：
10.1161/01.hyp.0000143851.23721.26
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发表时间：
2004-11-01
期刊：
影响因子：
8.3
通讯作者：
Pepine, CJ
中科院分区：
文献类型：
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作者：
Bakris, GL;Gaxiola, E;Pepine, CJ
国际维拉帕米 SR-群多普利研究 (INVEST) 的 22576 名参与者中有 6400 名 (28.3%) 在入组时患有糖尿病。这项预先设定的分析的目的是比较糖尿病队列中的抗高血压治疗策略（基于维拉帕米缓释剂的[n = 3169]与基于阿替洛尔的[n = 3231]）并确定主要结局的预测因子（首次发生全因死亡、非致命性心肌梗死或非致命性卒中的综合结果）。在平均 2.7 年的随访期间，913 名糖尿病患者经历了主要结局事件，治疗策略之间没有显着差异（维拉帕米 SR 为 14.6%，SR 为 13.9%；阿替洛尔风险比，1.05；95% 置信区间，0.92 至 1.19）。主要结局的风险随着基线心力衰竭、肾功能不全、美国居住、年龄、既往中风/短暂性脑缺血发作、既往心肌梗死、周围血管疾病或吸烟的存在而增加。随访期间的高收缩压和舒张压以及低舒张压也与风险增加相关。使用维拉帕米缓释剂或阿替洛尔策略进行抗高血压治疗，可使合并糖尿病的冠状动脉疾病 (CAD) 患者的心血管结局发生率相似。因此，对于患有 CAD 和糖尿病的成人患者，基于维拉帕米 SR 的抗高血压治疗策略是基于 β 受体阻滞剂的策略的替代方案。
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 beta-blocker-based strategy in adults with CAD and diabetes.