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Rethinking Lower Blood Pressure Goals for Diabetic Patients with Coronary Artery Disease – Findings from the INternational VErapamil SR – Trandolapril STudy (INVEST).

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  1. Rethinking Lower Blood Pressure Goals for Diabetic Patients with Coronary Artery Disease – Findings from the INternationalVErapamil SR – TrandolaprilSTudy (INVEST) Rhonda M. Cooper-DeHoff, Yan Gong, Eileen M. Handberg, Anthony A. Bavry, Scott J. Denardo, George L. Bakris and Carl J. Pepine on behalf of the INVEST Investigators University of Florida Gainesville, FL

  2. Disclosures • INVEST conduct and analysis was funded by Abbott Laboratories through 12/2008 • Cooper-DeHoff: research grant NHLBI (K23HL086558) • Handberg: unrestricted educational grants AstraZeneca, AtCor Medical, Daiichi Sankyo, Eli Lilly, Pfizer, Sanofi-Aventis, and Schering-Plough • Bakris: research grants Juvenile Diabetes Research Foundation, Glaxo Smith Kline, Forest Laboratories and CVRx; consultant Glaxo Smith Kline, Merck, Novartis, Boehringer-Ingelheim, Takeda, Abbott Laboratories, Walgreen’s, Bristol Meyer Squibb/Sanofi, Gilead, Forest Labs and CVRx. • Pepine: research grants NHLBI, Baxter, Pfizer, GlaxoSmithKline, and Bioheart, Inc; consultant Abbott Laboratories, Forest Labs, Novartis/Cleveland Clinic, NicOx, Angioblast, Sanofi-Aventis, NIH, Medtelligence, and SLACK Inc; unrestricted educational grants AstraZeneca, AtCor Medical, Daiichi Sankyo, Eli Lilly, Pfizer, Sanofi-Aventis, and Schering-Plough. • Gong, Bavry and Denardo: None

  3. Background Diabetes Care. 2010;33 Suppl 1:S11-61, Hypertension. 2003;42(6):1206-1252, Diabetes Care. 2002;25(1):199-201

  4. Objective To determine the effect of level of SBP reduction on adverse CV outcomes in a cohort of patients with diabetes and CAD

  5. Hypothesis Diabetic patients who achieved SBP <130 mm Hg would have reduced CV outcomes compared with diabetic patients who achieved SBP ≥130-<140 mm Hg

  6. INVEST Trial Design Pepine et al. JAMA. 2003:290:2805-2816

  7. Methods

  8. Results: Flow Diagram Dead 248 Tight Control 2,255 (35%) Dead 270 INVEST 22,576 (17,131 US) Alive, US 1,389 Alive 2,010 Alive 1,119 Dead 201 Usual Control 1,970 (31%) Diabetes 6,400 (5,077 US) Dead 259 Alive, US 1,423 Alive 1,769 Alive 1,164 Dead 334 Not Controlled 2,175 (34%) Dead 370 Alive, US 1,558 Alive 1,841 Alive 1,188 INVEST Follow Up 16,893 pt years Extended Follow Up 22,700 pt years 39,593 pt yrs

  9. Results: Baseline Characteristics

  10. Results – BP Reduction

  11. Results – Antihypertensive Drug Use Mean Number of Study + Nonstudy Antihypertenisve Drugs

  12. Results: Outcome Rates

  13. Results: Outcomes During INVEST

  14. Results: Outcomes – US Cohort Adj. HR 1.15, 95% CI 1.01-1.32, p=0.036 4 2 0 12 10 8 6

  15. Results: Outcomes – Tight Control Group (n=2,255) Reference

  16. Limitations

  17. Summary

  18. Conclusion

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