Verapamil Effective Alternate Therapy for Hypertension in Diabetics

Verapamil Effective Alternate Therapy for Hypertension in Diabetics
Verapamil is an effective alternate to beta-blockers as antihypertensive therapy for coronary artery disease patients with diabetes. Dr. George L. Bakris from Rush Medical University, Chicago, Illinois and colleagues in the International Verapamil SR-Trandolapril (INVEST) study compared antihypertensive treatment strategies in 6400 diabetics and sought predictors for the composite outcome of all-cause death, nonfatal myocardial infarction, or nonfatal stroke.

Both verapamil SR (n=3169) and atenolol (n=3231) resulted in similar reductions in blood pressure, the authors report. Moreover, there was no difference in the risk of the primary outcome or secondary outcomes or in the time to primary outcome between the two treatment strategies.

There was a trend for a reduced risk of the primary outcome when trandolapril 2 mg/day was added to the verapamil SR-based strategy and when hydrochlorthiazide 12.5 mg/day was added to the atenolol-based strategy, the report indicates, compared with an atenolol reference group.

Adverse events did not differ meaningfully between strategies, the researchers note.

Dr. Bakris noted that, “There is no difference in cardiovascular outcomes between verapamil and a beta blocker with regard to cardiovascular risk and events, but the calcium channel blocker is better tolerated.”

“Use of agents in combination that reduced cardiovascular risk and reduced risk of exacerbation of the metabolic syndrome, such as verapamil with an ACE inhibitor, did better in INVEST than a beta blocker and diuretic with regard to additional doctor visits and medications to treat those effects,” Dr. Bakris said. “So given similar outcomes, what is more convenient and better tolerated should be preferred.”

“Collectively, the results of INVEST and other recent trials underscore the importance of achieving the lower blood pressure goal of 130/80 mm Hg in patients with diabetes and hypertension that is currently recommended by a number of guideline committees in North America and Europe,” conclude Dr. Charles S. Brooks and Dr. James R. Sowers from University of Missouri-Columbia in a related editorial.

Hypertension 2004;44:614-615,637-642.