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.Trial RegistrationClinicaltrials.gov; NCT00133692

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

“…У пациентов, принимающих ББ, блокаторы I fканалов и недигидропиридиновые АК, рекомендовано учитывать их способность вызывать снижение ЧСС [1890][1891][1892][1893][1894]. У пациентов, получающих препараты с отрицательным хронотропным эффектом: ББ, недигидропиридиновые АК, сердечные гликозиды, антиаритмики III класса (амиодарон, соталол), следует учитывать их влияние на закономерную симптоматику.…”

Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects

“…Such comparison was performed in the International Verapamil SR-Trandolapril (INVEST) Ambulatory Monitoring Substudy, which did not reveal significant differences in the size of MBPS between verapamil and beta-blocker atenolol in patients with coronary artery disease. 71 …”

Ambulatory blood pressure monitoring and blood pressure control in patients with coronary artery disease—A randomized controlled trial

“…However achieving target BP as defined in guidelines is dismal according to registry data. [ 7 ], There is limited research regarding ambulatory blood pressure (ABP) in CAD or CVD-patients and such studies are usually descriptive and small in size [ [8] , [9] , [10] , [11] , [12] , [13] ], although intervention that lowered night ABP in CVD-patients was associated with improved outcome [ 14 ]. The presence of isolated office hypertension, isolated ambulatory hypertension and drug effects on 24 h blood pressure in this large and important group of patients is thus largely unknown.…”