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Verapamil, atenolol regimens equally effective after MI
5 August 2008
MedWire News: An antihypertensive regimen based on verapamil is at least as effective as one based on atenolol for controlling blood pressure (BP) and preventing cardiovascular events in patients with myocardial infarction (MI), shows an INVEST substudy.
There was also a trend toward less angina pectoris and stroke among MI patients taking the long-acting calcium channel blocker (verapamil), relative to those taking the beta blocker (atenolol).
Also, 82.3% of the 3622 patients assigned to the verapamil-based regimen reported good or excellent well-being after 24 months of treatment, compared with 78.0% of the 3596 patients on the atenolol-based regimen (p=0.02).
Poor patient adherence to beta blockers can be a major barrier to effective BP reduction with these drugs, note Franz Messerli (Columbia University College of Physicians and Surgeons, New York, USA) and colleagues. They cite a study in which, for every MI or stroke prevented with beta-blocker treatment, 10 patients discontinued treatment because of fatigue or impotence.
In the INVEST (International Verapamil SR-Trandolapril) study, hypertensive patients with coronary artery disease were randomly assigned to receive verapamil slow release (SR) 240 mg/day with an additional ACE inhibitor if needed, or atenolol 50 mg/day with an additional diuretic if required.
The two regimens proved equally effective, and the current study, which appears in the American Heart Journal, confirms the finding in the subset of patients with prior MI.
After 24 months, average BP was virtually identical in both treatment groups. During an average 2.8 years of follow-up, 14.0% of patients suffered a primary endpoint event (death, nonfatal MI, nonfatal stroke) - 13.7% in the verapamil group and 14.4% in the atenolol group.
There was, however, a nonsignificant 29% reduction in the rate of nonfatal stroke among patients taking the verapamil versus atenolol regimens (1.4% vs 2.0%, p=0.06), and a trend toward less angina (12.0% vs 14.3%, p=0.07).
"Thus, in hypertensive patients with a prior MI unable to tolerate a beta blocker, a verapamil-SR-based strategy may be an acceptable alternative for the secondary prevention of cardiovascular events," concludes the team.
