title: Effects of verapamil SR and atenolol on 24-hour blood pressure and heart rate in hypertension patients with coronary artery disease: an international verapamil SR-trandolapril ambulatory monitoring substudy.
abstract: Elevated nighttime blood pressure (BP) and heart rate (HR), increased BP and HR variability, and altered diurnal variations of BP and HR (nighttime dipping and morning surge) in patients with systemic hypertension are each associated with increased adverse cardiovascular events. However, there are no reports on the effect of hypertension treatment on these important hemodynamic parameters in the growing population of hypertensive patients with atherosclerotic coronary artery disease (CAD). This was a pre-specified subgroup analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable patients aged ≥ 50 years with hypertension and CAD randomized to either verapamil SR- or atenolol-based hypertension treatment strategies. The subgroup consisted of 117 patients undergoing 24-hour ambulatory monitoring at baseline and after 1 year of treatment. Hourly systolic and diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR- and atenolol-based treatment strategies compared with baseline (P<0.0001). Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies decreased SBP variability (weighted standard deviation: P = 0.012 and 0.021, respectively). Compared with verapamil SR, atenolol also increased the prevalence of BP and HR nighttime dipping among prior non-dippers (BP: OR = 3.37; 95% CI: 1.26-8.97 P = 0.015; HR: OR = 4.06; 95% CI: 1.35-12.17; P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5 beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based strategies resulted in favorable changes in ambulatory monitoring parameters that have been previously associated with increased adverse cardiovascular events.
authors.affiliation: Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Denardo
authors.affiliation: Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gong
authors.affiliation: Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Cooper-DeHoff
authors.affiliation: St Imre Teaching Hospital Cardiometabolic Centre, Budapest, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Farsang
authors.affiliation: Semmelweis University, Hungarian Institute of Cardiology, Budapest, Hungary.
authors.forename: Matyas
authors.initials: M
authors.lastname: Keltai
authors.affiliation: N&Sz StudyMaster Medical Research Center Ltd., Szentendre, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Szirmai
authors.affiliation: Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University, College of Medicine and Physicians, New York, New York, United States of America.
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
authors.affiliation: Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America; North Florida/South Georgia Veterans Affairs Health System, Gainesville, Florida, United States of America.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
authors.affiliation: Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Handberg
authors.affiliation: Clinica Medica, Ospedale San Gerardo dei Tintori Monza, University of Milano-Bicocca, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.affiliation: Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D017440:Photoperiod; D011446:Prospective Studies; D014700:Verapamil / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D007211:Indoles; C052035:trandolapril; D001262:Atenolol; D014700:Verapamil
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