Cardiac Event Rates After Acute Myocardial Infarction in Patients Treated With Verapamil and Trandolapril Versus Trandolapril Alone

Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease

“…The largest of these trials is the DAnish Verapamil Infarction Trial (DAVIT), which showed a trend in reducing the outcomes of death or nonfatal MI in 3447 patients with suspected acute coronary syndromes administered intravenous verapamil at admission and then orally for 1 week. 112 In the Diltiazem Reinfarction Study (DRS), 113 576 patients were treated with diltiazem or placebo 24 to 72 hours after the onset of non-Q-wave MI. There was a significant reduction in reinfarction and refractory angina at 14 days.…”

“…95,132,133 However, no harm was observed in 1 study with verapamil in patients with HF after an acute MI, all of whom were treated with ACE inhibitors. 112 Long-acting dihydropyridine CCBs are preferred after an acute MI for patients with continuing ischemic discomfort or rapid ventricular arrhythmias who are unresponsive to ␤-blockers or in whom ␤-blockers are contraindicated. Nondihydropyridine CCBs (diltiazem and verapamil) should be avoided in patients with modest to severe HF or bradyarrhythmias.…”

The Appropriate Blood Pressure Control in Diabetes (ABCD) Trial

“…12 Taken together, these observations clearly indicate that in patients with pre-existing cardiovascular or renal disease, dihydropyridine CCAs, when used without an ACE inhibitor, may reduce arterial pressure but fail to offer protection from the natural history of cardiovascular or renal disease. 12 It is clear, however, from smaller clinical studies as well as previously mentioned trials that both reductions in cardiovascular events as well as renal disease progression is observed when blood pressure reduction occurs with non-dihydropyridine CCAs. 5,6,[10][11][12] The first true clinical trial in diabetic nephropathy, however, that provides evidence for a clear difference between dihydropyridine CCAs and ACE inhibitors comes from the recently published Appropriate Blood Pressure Control and Diabetes Trial (ABCD Trial).…”

“…12 It is clear, however, from smaller clinical studies as well as previously mentioned trials that both reductions in cardiovascular events as well as renal disease progression is observed when blood pressure reduction occurs with non-dihydropyridine CCAs. 5,6,[10][11][12] The first true clinical trial in diabetic nephropathy, however, that provides evidence for a clear difference between dihydropyridine CCAs and ACE inhibitors comes from the recently published Appropriate Blood Pressure Control and Diabetes Trial (ABCD Trial). 13 This trial has, as its primary objective, to determine the relative effects of moderate and intensive blood pressure control on the change in creatinine clearance among both normotensive and hypertensive patients all of whom had type 2 diabetes.…”

“…[4][5]19,20 This benefit may be accentuated when non-dihydropyridine CCAs are used in concert with ACE inhibitors. 12,19,20 Thus, these discrepancies in cardiovascular outcomes of various studies including the ABCD Trial should remind us to be cautious with data extrapolation from a population with established renal disease from diabetes to those with an absence of end organ failure and hypertension alone.…”