INVEST revisited: review of findings from the International Verapamil SR-Trandolapril Study.
INVEST revisited: review of findings from the International Verapamil SR-Trandolapril Study.
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DOI：
10.1586/erc.09.102
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发表时间：
2009-11
影响因子：
2
通讯作者：
Pepine CJ
中科院分区：
文献类型：
--
作者：
Cooper-DeHoff RM;Handberg EM;Mancia G;Zhou Q;Champion A;Legler UF;Pepine CJ
国际维拉帕米SR- trandolapril研究（INVEST）是一项随机试验，共有22,576名主要为老年患者，平均随访2.7年，比较了钙拮抗剂主导的策略（维拉帕米SR + trandolapril）和β受体阻滞剂主导的策略（阿替洛尔+氢氯噻嗪）在高血压治疗和冠状动脉疾病心血管结局预防方面的作用。病人。患者按照灵活的、多药物的、基于指南的治疗算法接受个体化剂量和药物滴定，目标是针对合并症（如糖尿病）实现最佳血压控制。主要结局（PO）为首次死亡（全因）、非致死性心肌梗死或非致死性卒中。两种策略的降压效果非常相似，大约70%的患者达到了血压控制（< 140/90 mm Hg）。BP处于控制状态的患者就诊次数的增加与PO风险的降低有关。总的来说，两种治疗方案在PO方面没有差异，但是阿替洛尔组新发糖尿病的发生率更高。本报告总结了INVEST的研究结果，并将其与我们目前从其他大型高血压治疗试验中获得的知识相结合。INVEST的研究结果支持：1)血压降低对预防不良心血管发病率和死亡率很重要；2)降压药的选择应基于患者的合并症和其他危险因素（如糖尿病风险），而不一定要给所有人服用一种药物。
The INternational VErapamil SR-Trandolapril STudy (INVEST), a randomized trial of 22,576 predominantly elderly patients with an average 2.7-year follow-up, compared a calcium antagonist led strategy (verapamil SR plus trandolapril) with a β blocker led strategy (atenolol plus hydrochlorothiazide) for hypertension treatment and prevention of cardiovascular outcomes in coronary artery disease. patients. Patients received individualized dose and drug titration following a flexible, multi-drug, guideline-based treatment algorithm, with the objective of achieving optimal blood pressure (BP) control individualized for comorbidities (e.g., diabetes). The primary outcome (PO) was first occurrence of death (all-cause), nonfatal myocardial infarction or nonfatal stroke. The strategies resulted in significant and very similar BP reduction with approximately 70% of patients in both strategies achieving BP control (< 140/90 mm Hg). Increasing number of office visits with BP in control was associated with reduced risk of the PO. Overall, there was no difference in the PO comparing the strategies, however new onset diabetes occurred more frequently in those assigned the atenolol strategy. This report summarizes findings from INVEST and puts them in perspective with our current state of knowledge derived from other large hypertension treatment trials. INVEST findings support that 1) BP reduction is important for prevention of adverse cardiovascular morbidity and mortality; and 2) selection of antihypertensive agents should be based on patient comorbidities and other risk factors (e.g. risk for diabetes) and not necessarily that any one drug be given to all.