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No Differences Seen Between Calcium Channel Blocker and Beta Blocker in INVEST Trial: Presented at ACC

By Ed Susman

CHICAGO, IL -- April 2, 2003 -- A strategy that treats patients with a calcium channel blocker-based regimen for high blood pressure proved virtually identical to a beta blocker-based regimen in a 22,576-patient study.

Results from the International Verapamil SR and Trandolapril Study (INVEST) were presented here April 2ⁿd at the 52^nd Annual Scientific Sessions of the American College of Cardiology (ACC).

"Now there's an alternative to what's considered the standard of care," said the study's chief investigator, Carl Pepine, MD, chief of cardiovascular medicine, University of Florida College of Medicine. Dr. Pepine is the new president of the ACC.

Dr. Pepine noted that nearly all aspects of treatment between the two groups were indistinguishable from each other, and that more than 60% of the patients in the trial were able to reach their blood pressure goal. All the patients in the trial had high blood pressure and documented heart disease. More than half were over 65 years or age.

"Calcium channel blockers have been oft-maligned," said James Ferguson III, MD, associate director of cardiovascular research, Texas Heart Institute, Houston, Texas. "However, I don't think that calcium channel blockers needed to be rehabilitated. This study confirms their utility in treating patients with high blood pressure and should give confidence to doctors who prescribe them -- and to patients who are taking these drugs -- that they are getting therapy that is up to the standard of care."

In the INVEST trial, Dr. Pepine said, "there are no differences in either the systolic or diastolic blood pressure levels between the two strategies at any time point during the 4 years of follow-up."

Patients on the verapamil based strategy showed an 18.6-point drop in systolic pressure and a 9.9-point decrease in diastolic pressure, while the patients on the beta blocker achieved an 18.9-point decrease and a 10.2-point decrease, respectively.

"Blood pressure control by either strategy was excellent in INVEST," Dr. Pepine said. "About 64% of patients in both strategies achieved blood pressure control." That finding is in contrast to surveys that indicate only about 30% of patients in the United States have their blood pressure under control.

About 20% of patients in each treatment group experienced a cardiovascular event -- showing that both strategies were similar in safety. Dr. Pepine said there were no statistically significant differences in rates of death, heart attack, stroke, or other event between the two groups of patients. For example, 848 people in the study who were in the calcium channel blocker group died compared with 862 people in the beta blocker group -- no statistical difference.

In the trial, patients who were assigned to receive the calcium channel blockers were allowed to add the angiotensin-converting enzyme inhibitor trandolapril to their regimen in order to control blood pressure. If response was not optimal, they were allowed to add diuretics to the regimen. The other patients were begun on beta blockers and then were allowed to add diuretics and then trandolapril to get blood pressure to goal.

Franz Messerli, MD, another investigator in the trial, said the results give him and other clinicians another option for treating patients. "Beta blocker-type drugs, for example, are not very well tolerated," he said.

Dr. Pepine noted that more patients in the beta blocker group switched regimen than in the calcium channel blocker group.

The trial was supported by Abbott Laboratories.


[Study title: International Verapamil-Trandolapril Study. Abstract: 421-11]

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