Beta-blocker or calcium antagonist-based therapies equally effective in treating hypertension

Hypertensive patients with coronary artery disease had similar outcomes when they took a beta-blocker therapy or a calcium antagonist-based therapy, according to a study in the December 3 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, despite conclusive evidence of the effectiveness of medications to treat high blood pressure in patients with hypertension in general, safety and efficacy of antihypertensive medications in patients with coronary artery disease (CAD) have been discerned only from the analyses of subgroups in large trials.

Carl J. Pepine, M.D., of the University of Florida College of Medicine, Gainesville, Fla., and colleagues designed a randomized trial, the International Verapamil-Trandolapril Study (INVEST), to compare outcomes in older hypertensive patients with CAD treated with a calcium antagonist strategy (CAS; verapamil sustained release [SR]) or a beta-blocker, non-calcium antagonist strategy (NCAS; atenolol). Because most hypertensive patients require more than 1 agent to adequately control blood pressure, INVEST was intended to compare multidrug strategies rather than individual agents. The study included 22,576 hypertensive CAD patients aged 50 years or older, and was conducted September 1997 to February 2003 at 862 sites in 14 countries.

The medications trandolapril and/or hydrochlorothiazide were administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment.

After an average follow-up of 2.7 years per patient, 2,269 patients had a primary outcome event (death, nonfatal heart attack, or nonfatal stroke) with no statistically significant difference between treatment strategies (9.93 percent in CAS and 10.17 percent in NCAS). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0 percent (systolic) and 88.5 percent (diastolic) of CAS patients and 64.0 percent (systolic) and 88.1 percent (diastolic) of NCAS patients. A total of 71.7 percent of CAS patients and 70.7 percent of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg.

“In conclusion, our results indicate that lower targets for blood pressure control can be achieved in most hypertensive patients with CAD using a multidrug strategy that includes administration of angiotensin-converting enzyme (ACE) inhibitors to patients with heart failure, diabetes, or renal impairment. The clinical equivalence of the CAS and NCAS groups in prevention of death, [heart attack], or stroke supports the use of either strategy in clinically stable patients with CAD who require blood pressure control. The decision regarding which drug classes to use in specific CAD patients should be based on additional factors including adverse experiences, history of heart failure, diabetes risk, and the physician’s best judgment,” the authors write.

Media Contact

Melanie Fridlross EurekAlert!

Weitere Informationen:

http://jama.com/

Alle Nachrichten aus der Kategorie: Health and Medicine

This subject area encompasses research and studies in the field of human medicine.

Among the wide-ranging list of topics covered here are anesthesiology, anatomy, surgery, human genetics, hygiene and environmental medicine, internal medicine, neurology, pharmacology, physiology, urology and dental medicine.

Zurück zur Startseite

Kommentare (0)

Schreib Kommentar

Neueste Beiträge

Argonne targets lithium-rich materials as key to more sustainable cost-effective batteries

Next-generation batteries using lithium-rich materials could be more sustainable and cost-effective, according to a team of researchers with the U.S. Department of Energy’s (DOE) Argonne National Laboratory. The pivotal discovery,…

Why disordered light-harvesting systems produce ordered outcomes

Scientists typically prefer to work with ordered systems. However, a diverse team of physicists and biophysicists from the University of Groningen found that individual light-harvesting nanotubes with disordered molecular structures…

RadarGlass – from vehicle headlight to radar transceiver

As a result of modern Advanced Driver Assistance Systems, the use of radar technology has become indispensable for the automotive sector. With the installation of a large and growing number…

By continuing to use the site, you agree to the use of cookies. more information

The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.

Close