Blood pressure control and cardiovascular outcomes in high-risk Hispanic patients--findings from the International Verapamil SR/Trandolapril Study (INVEST).
BACKGROUND
People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease (CAD).


RESULTS
An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14,531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension. After 61,835 patient-years of follow-up, treatment with either a verapamil sustained release (SR) or atenolol antihypertensive strategy resulted in greater blood pressure control in Hispanic patients, and Hispanic patients were at significantly lower risk of experiencing a nonfatal myocardial infarction, nonfatal stroke, or death (hazard ratio [HR] 0.87, 95% CI 0.78-0.97). Hispanic ethnicity was associated with an increase (HR 1.19, 95% CI 1.04-1.36), and randomization to the verapamil SR strategy was associated with a decrease (HR 0.85, 95% CI 0.76-0.95), in the risk of new-onset diabetes. Use of trandolapril in the verapamil SR strategy was associated with reduced risk of new-onset diabetes, whereas increasing doses of atenolol and hydrochlorothiazide in the atenolol strategy were associated with increased risk of new-onset diabetes.


CONCLUSIONS
The Hispanic cohort of INVEST had better blood pressure control and lower risk of adverse cardiovascular outcomes compared with the non-Hispanic cohort. A verapamil SR strategy is an alternative to an atenolol strategy for the treatment of Hispanic patients with hypertension and CAD and can reduce the risk of new-onset diabetes.
Cooper-DeHoff
Rhonda M
RM
University of Florida College of Medicine, Gainesville, FL, USA. dehofrm@medicine.ufl.edu
Aranda
Juan M
JM
Gaxiola
Efrain
E
Cangiano
Jose L
JL
Garcia-Barreto
David
D
Conti
C Richard
CR
Hewkin
Ann
A
Pepine
Carl J
CJ
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications* / Q000208:ethnology; D003692:Delayed-Action Preparations; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013599:Systole; D016896:Treatment Outcome; D014700:Verapamil / Q000008:administration & dosage / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D003692:Delayed-Action Preparations; D007211:Indoles; C052035:trandolapril; D001262:Atenolol; D014700:Verapamil