INVEST (http://www.clinicaltrials.gov identifier: NCT00133692) was funded by a grant from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, Abbott Park, IL; and the University of Florida Research Foundation and Opportunity Fund. Dr. Cooper-DeHoff's effort is funded by National Heart, Lung, and Blood Institute (NHLBI) K23HL086558. Dr. Pepine receives support in part from the National Institutes of Health (NIH)/National Center for Research Resources Clinical and Translational Science Award to the University of Florida UL1 TR000064. BASF Pharma and Abbott Laboratories had no role in the design or conduct of the study, collection or analysis of data, or preparation or approval of the manuscript.
Quality and Outcome
Mortality Implications of Angina and Blood Pressure in Hypertensive Patients With Coronary Artery Disease: New Data From Extended Follow-up of the International Verapamil/Trandolapril Study (INVEST)
Article first published online: 29 MAY 2013
© 2013 Wiley Periodicals, Inc.
Volume 36, Issue 8, pages 442–447, August 2013
How to Cite
Winchester, D. E., Cooper-DeHoff, R. M., Gong, Y., Handberg, E. M., Pepine, C. J. and for the INVEST Investigators (2013), Mortality Implications of Angina and Blood Pressure in Hypertensive Patients With Coronary Artery Disease: New Data From Extended Follow-up of the International Verapamil/Trandolapril Study (INVEST). Clin Cardiol, 36: 442–447. doi: 10.1002/clc.22145
Dr. Cooper-DeHoff reported receiving research funding from Abbott Laboratories during the conduct of INVEST. Dr. Handberg reported receiving grant support from the NHLBI, Abbott Laboratories, Fujisawa, Pfizer, and GlaxoSmithKline and educational grants from the Vascular Biology Working Group (AstraZeneca, Sanofi Aventis, Schering-Plough, Daiichi Sankyo Lilly, AtCor Medical, XOMA). Dr. Pepine reported receiving research grants from the NHLBI, Abbott Laboratories, Baxter, Pfizer, GlaxoSmithKline, and Bioheart Inc; serving as consultant for Abbott Laboratories, Forest Laboratories, Novartis/Cleveland Clinic, NicOx, Angioblast, Sanofi-Aventis, NHLBI, NIH, Medtelligence, and SLACK Inc; and receiving unrestricted educational grants from AstraZeneca, AtCor Medical Inc, Daiichi Sankyo Inc, Eli Lilly, Pfizer Inc, Sanofi-Aventis, and Schering-Plough. Drs. Winchester and Gong reported that they have no financial disclosures.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 12 AUG 2013
- Article first published online: 29 MAY 2013
- Manuscript Revised: 18 APR 2013
- Manuscript Received: 7 MAR 2013
Angina and hypertension are common in patients with coronary artery disease (CAD); however, the effect on mortality is unclear. We conducted this prespecified analysis of the International Verapamil/Trandolapril Study (INVEST) to assess relationships between angina, blood pressure (BP), and mortality among elderly, hypertensive CAD patients.
Angina and elevated BP will be associated with higher mortality.
Extended follow-up was performed using the National Death Index for INVEST patients in the United States (n = 16 951). Based on angina history at enrollment and during follow-up visits, patients were divided into groups: persistent angina (n = 7184), new-onset angina (n = 899), resolved angina (n = 4070), and never angina (n = 4798). Blood pressure was evaluated at baseline, during drug titration, and during follow-up on-treatment. On-treatment systolic BP was classified as tightly controlled (<130 mm Hg), controlled (130–139 mm Hg), or uncontrolled (≥140 mm Hg). A Cox proportional hazards model was created adjusting for age, heart failure, diabetes, renal impairment, myocardial infarction, stroke, and smoking. The angina groups and BP control groups were compared using the never-angina group as the reference.
Only in the persistent-angina group was a significant association with mortality observed, with an apparent protective effect (hazard ratio: 0.82, 95% confidence interval: 0.75-0.89, P < 0.0001). Uncontrolled BP was associated with increased mortality risk (hazard ratio: 1.29, 95% confidence interval: 1.20-1.40, P < 0.0001), as were several other known cardiovascular risk factors.
In hypertensive CAD patients, persistent angina was associated with lower mortality. The observed effect was small compared with other cardiovascular risk factors, such as BP, which were associated with increased mortality.