CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 1, January/February 2010
54
AFRICA
Analysis from this substudy is underway
and publications will be forthcoming.
Overall, the primary outcome of
INVEST was not statistically significant-
ly different between the two treatment
arms; although new-onset diabetes was
lower in the verapamil SR/trandolapril
arm than in the atenolol/HTCZ arm. In
fact, patients in the verapamil plus tran-
dolapril-based group were 15% less likely
to develop new-onset diabetes during
follow up. Blood pressure lowering was
almost identical in both treatment strate-
gies, with more than 70% of patients
reaching target blood pressure of less than
140/90 mmHg.
Angina episodes were reduced by
some 50%, with fewer angina episodes
being experienced with the verapamil
SR/trandolapril strategy. Interestingly,
patients with diabetes were taking on
average three antihypertensive medica-
tions. Depression improved significantly
in the verapamil-treated group, as did
quality of life. Both treatment strategies
were well tolerated.
The major contrast between INVEST
and the two later studies, ASCOT and
LIFE, is that atenolol was dosed twice
daily, resulting in the more equivalent
outcomes in INVEST.
This expert review of INVEST
concludes that the selection of antihyper-
tensive agents should be based on patients
co-morbidities and other risks, impor-
tantly the risk of developing diabetes. Key
findings are summarised in Table 1.
Cooper-DeHoff RM, Handberg EM, Mancia
1.
G, Zhou Q, Champion A, Legler UF, Pepine
CJ. INVEST revitalised: A review of the
findings from International Verapamil
SR-Trandolopril study (INVEST).
Expert Rev
Cardiovasc Ther
2009;
7
(11): 1329–1340.
Dahlof B, Sever PS, Poulter NR,
2.
et al
.
Prevention of cardiovascular events with
an antihypertensive regimen of amlodipine
adding perindopril as required versus aten-
olol adding bendroflumethiazide as required,
in the Anglo Scandinavian Cardiac Outcomes
Trial – BP lowering arm (ASCOT-BPLA)
a multicentre randomised controlled trial.
Lancet
2005;
366
(9489): 895–906.
Jamerson K. ACCOMPLISH ambulatory
3.
blood pressure monitoring substudy data
presented as late breaking clinical trial at
the American Society of Hypertension, 2009
scientific sessions. San Francisco, California,
2009.
Drug Trends in Cardiology. INVEST endors-
4.
es verapamil in hypertensives with CAD
highlights diabetes prevention.
Cardiovasc J
South Afr
2003;
14
(4); 208, 210–211.
Lichtman JH, Bigger JT (jun) Blumenthal JA,
5.
et al
. Depression and coronary heart disease:
recommendations for screening, referral
and treatment: a science advisory from the
American Heart Association Prevention
Committee of the Council on Cardiovascular
Nursing, Council on Clinical Cardiology,
Council on Epidemiology and Prevention,
and Interdisciplinary Council on Quality
of Care and Outcomes Research: endorsed
by the American Psychiatric Association.
Circulation
2008;
118
(17): 1768–1775.
Reid LD, Tueth MJ, Handberg E, Kupfer
6.
S, Pepine CJ. A study of antihypertensive
drugs and depressive symptoms (SADD-
Sx) in patients treated with a calcium
antagonist versus an atenolol hypertension
treatment strategy in the international vera-
pamil SR-trandolapril study (INVEST).
Pharmacogenet Genomics
2007;
17
(9):
719–729.
Watch these dates
Date
Event
Place
Contact
14–16 March
59th American College of Cardiology Congress. scientific sessions
Atlanta, Georgia, USA
17–19 March
7th scientific congress of the Cameroon Cardiac Society (CCS)
Yaounde, Cameroon
26–29 March
Cardiology at the Limits
Cape Town
23–26 May
22nd biennial symposium of Department of Surgery
Sandton Convention
Centre, Gauteng
16–19 June
World Congress of Cardiology
Beijing, China
24–27 July
International Academy of Cardiology, 15th world congress on heart disease Vancouver, Canada
8–11 August
SA Heart Association congress
Sun City, North West
28 Aug – 1 September European Society of Cardiology Congress (ESC)
Stockholm, Sweden
14–17 October
Vascular Society of Southern Africa congress (VASSA)
KwaMaritane,
North West Province
13–17 November
American Heart Association
Chicago, Illinois, USA
