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). Methods and Results An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension. After 61835 patient-years of follow-up, treatment with either a verapamil sustained release (SR) or atenolol anti hypertensive 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% Cl 0.78-0.97). Hispanic ethnicity was associated with an increase (HR 1.19, 95% Cl 1.04-1.36), and randomization to the verapamil SIR strategy was associated with a decrease (HR 0.85, 9.5% Cl 0.76-0.95), in the risk of new-onset diabetes. Use of trandolapril in the verapamil SIR 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 SIR 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.