Verapamil-sustained release-based treatment strategy is equivalent to atenolol-based treatment strategy at reducing cardiovascular events in patients with prior myocardial infarction: An INternational VErapamil SR-Trandolapril (INVEST) substudy
Verapamil-sustained release-based treatment strategy is equivalent to atenolol-based treatment strategy at reducing cardiovascular events in patients with prior myocardial infarction: An INternational VErapamil SR-Trandolapril (INVEST) substudy
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DOI：
10.1016/j.ahj.2008.02.023
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发表时间：
2008-08-01
影响因子：
4.8
通讯作者：
Pepine, Carl J.
中科院分区：
文献类型：
--
作者：
Bangalore, Sripal;Messerli, Franz H.;Pepine, Carl J.
背景：在既往有心肌梗死(MI)史的患者中，β-受体阻滞剂可使死亡率降低23%至40%。然而，尽管有这种有利的效果，但不良反应限制了这种药物的依从性。本研究的目的是比较P-受体阻滞剂策略和降心率钙拮抗剂策略在既往心肌梗死患者中的作用。方法我们评估了7218例既往心肌梗死患者，这些患者参加了国际维拉帕米缓释(SR)或阿替洛尔(Atenolol)随机分组研究。主要结果是首次死亡(全因)、非致命性心肌梗塞或非致命性中风的发生时间。次要结果包括分别考虑的死亡、总MI(致命性和非致命性)和总卒中(致命性和非致命性)。结果在2.8+/-1.0年的随访中，基于维拉帕米的患者和基于阿替洛尔的患者具有相似的血压控制，主要结果的发生率相同。在死亡或完全心肌梗死的结局方面，两种策略之间没有差异。然而，更多的患者在24个月时报告了更多的优/良(82.3%比78.0%，P=0.02)，心绞痛(12.0%比14.3%，调整后P=0.07)，非致命性中风(1.4%比2.0%；结论在既往有心肌梗死史的高血压患者中，基于维拉帕米的策略与基于P受体阻滞剂的策略在控制血压和预防心血管事件方面是相同的，具有更强的主观幸福感，心绞痛和卒中的发生率有降低的趋势。
Background In patients with prior myocardial infarction (MI), beta-blockers reduce mortality by 23% to 40%. However, despite this favorable effect, adverse effects limit compliance to this medication. The purpose of the study was to compare a P-blocker-based strategy with a heart rate-lowering calcium antagonists-based strategy in patients with prior MI.Methods We evaluated 7,218 patients with prior MI enrolled in the INternational VErapamil SR-Trandolapril (INVEST) substudy randomized to verapamil-sustained release (SR)- or atenolol-based strategies. Primary outcome was time to first occurrence of death (all-cause), nonfatal MI, or nonfatal stroke. Secondary outcomes included death, total MI (fatal and nonfatal), and total stroke (fatal and nonfatal) considered separately.Results During the 2.8 +/- 1.0 years of follow-up, patients assigned to the verapamil-SR-based and atenolol-based strategies had comparable blood pressure control, and the incidence of the primary outcome was equivalent. There was no difference between the 2 strategies for the outcomes of either death or total MI. However, more patients reported excellent/ good well-being (82.3% vs 78.0%, P = .02) at 24 months with a trend toward less incidence of angina pectoris (12.0% vs 14.3%, adjusted P = .07), nonfatal stroke (1.4% vs 2.0%; P = .06), and total stroke (2.0% vs 2.5%, P = .18) in the verapamil-SR-based strategy group.Conclusions In hypertensive patients with prior MI, a verapamil-SR-based strategy was equivalent to a P-blocker-based strategy for blood pressure control and prevention of cardiovascular events, with greater subjective feeling of well-being and a trend toward lower incidence of angina pectoris and stroke in the verapamil-SR-based group.