Blood pressure control and cardiovascular outcomes in high-risk Hispanic patients—Findings From the International Verapamil SR/Trandolapril Study (INVEST)

Cooper‐DeHoff, Rhonda M.; Aranda, Juan M.; Gaxiola, Efraín; Cangiano, José L.; García-Barreto, D; Conti, C. Richard; Hewkin, Ann C.; Pepine, Carl J.

doi:10.1016/j.ahj.2005.05.024

Cited by 65 publications

(60 citation statements)

References 33 publications

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“…This suggests that biological factors are less likely to explain the differences in blood pressure control between Hispanics and whites observed in our study. 25,26 On the contrary, differences in the biology of the disease should be considered for black patients: it has been suggested that black patients have more aggressive forms of hypertension compared with white patients, and they are more prone to hypertension-related complications. [27][28][29] Also, black patients differ in responsiveness to various antihypertensive drug classes.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension

Desai

et al. 2017

Circ: Cardiovascular Quality and Outcomes

133

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Background-A key to reduce and eradicate racial disparities in hypertension outcomes is to understand their causes.We aimed at evaluating racial differences in antihypertensive drug utilization patterns and blood pressure control by insurance status, age, sex, and presence of comorbidities. Methods and Results-A total of 8796 hypertensive individuals ≥18 years of age were identified from the National Health and Nutrition Examination Survey (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) Racial disparities also persisted in subgroups stratified by age (≥60 and <60 years of age) and presence of comorbidities but worsened among patients <60 years of age. Conclusions-Black and Hispanic patients had poorer hypertension control compared with whites, and these differences were more pronounced in younger and uninsured patients. Although black patients received more intensive antihypertensive therapy, Hispanics were undertreated. Future studies should further explore all aspects of these disparities to improve cardiovascular outcomes. (Circ Cardiovasc Qual Outcomes. 2017;10:e003166.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension

Desai

et al. 2017

Circ: Cardiovascular Quality and Outcomes

133

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“…15 Superior BP control among Hispanic compared with non-Hispanic participants was also reported in the International Verapamil SR/Trandolapril Trial, but the data were not separated by race among the Hispanics. 16 Hispanic ALLHAT participants were more likely than non-Hispanic participants to have uncontrolled BP at enrollment into the study. Although a similarly high proportion (90%) reported treatment with antihypertensive medications in all of the race/ethnic groups at entry, it is possible that the number of drugs, types of drugs, dosage, or adherence differed between Hispanics and non-Hispanics.…”

Section: Margolis Et Al Blood Pressure Control In Hispanics In Allhatmentioning

confidence: 99%

“…33 Although there has been relatively little study of the efficacy of various classes of antihypertensive drugs in Hispanics, the published literature does not suggest much variation in response to antihypertensive drugs. 16,34,35 Thus, Hispanic patients likely face barriers to hypertension screening, initiation of therapy, and appropriate intensification of therapy. An alternative explanation for better BP control in ALLHAT Hispanic participants could be that they differed systematically from non-Hispanic participants in ways not measured in ALLHAT.…”

Section: Margolis Et Al Blood Pressure Control In Hispanics In Allhatmentioning

confidence: 99%

Blood Pressure Control in Hispanics in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

et al. 2007

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Abstract-Historically, blood pressure control in Hispanics has been considerably less than that of non-Hispanic whites and blacks. We compared determinants of blood pressure control among Hispanic white, Hispanic black, non-Hispanic white, and non-Hispanic black participants (Nϭ32 642) during follow-up in a randomized, practice-based, activecontrolled trial. Hispanic blacks and whites represented 3% and 16% of the cohort, respectively; 33% were non-Hispanic black and 48% were non-Hispanic white. Hispanics were less likely to be controlled (Ͻ140/90 mm Hg) at enrollment, but within 6 to 12 months of follow-up, Hispanics had a greater proportion Ͻ140/90 mm Hg compared with non-Hispanics. At 4 years of follow-up, blood pressure was controlled in 72% of Hispanic whites, 69% of Hispanic blacks, 67% of non-Hispanic whites, and 59% of non-Hispanic blacks. Compared with non-Hispanic whites, Hispanic whites had a 20% greater odds of achieving BP control by 2 years of follow-up (odds ratio: 1.20; 95% CI: 1.10 to 1.31) after controlling for demographic variables and comorbidities, Hispanic blacks had a similar odds of achieving BP control (odds ratio: 1.04; 95% CI: 0.86 to 1.25), and non-Hispanic blacks had a 27% lower odds (odds ratio: 0.73; 95% CI: 0.69 to 0.78). We conclude that in all patients high levels of blood pressure control can be achieved with commonly available medications and that Hispanic ethnicity is not associated with inferior control in the setting of a clinical trial in which hypertensive patients had equal access to medical care, and medication was provided at no cost.

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“…In a recent publication, the Hispanic cohort of INVEST also yielded better BP control compared with the non-Hispanic cohort after 24 months of treatment with a mean of 2.4 drugs required to achieve BP control. 5 From the present analysis, one might conclude that a substantial proportion of BP control after 24 months can be attributed to trandolapril addition to verapamil SR, which justifies the administration of these drug classes in Hispanics. The Hispanic subpopulation of the present study was recruited from countries in North and Central America and the Caribbean, with a high percentage from Puerto Rico.…”

Section: Discussionmentioning

confidence: 97%

Factors Influencing Blood Pressure Response to Trandolapril Add-On Therapy in Patients Taking Verapamil SR (from the International Verapamil SR/Trandolapril [INVEST] Study)

Brunner

Cooper‐DeHoff

Gong

et al. 2007

The American Journal of Cardiology

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Factors such as age and race/ethnicity might influence blood pressure (BP) response to drugs. Therapeutic response to the angiotensin-converting enzyme inhibitor trandolapril used as add-on therapy to stable calcium channel blocker therapy with verapamil sustained release 240 mg was addressed in a racially/ethnically diverse group of 1,832 hypertensive patients with coronary artery disease. Furthermore, the association with a polymorphism (1166A→C) in the angiotensin II type 1 receptor gene (AGTR1) was tested. BP response was compared between groups using analysis of covariance after adjustment for covariates associated with BP response. Genotyping was performed using polymerase chain reaction and pyrosequencing. Trandolapril decreased mean unadjusted systolic and diastolic BPs by −9.1 ± 17.3 (SD) and −4.1 ± 10.1 mm Hg, respectively. The percentage of patients with BP under control (<140/90 mm Hg) increased from 6.7% to 41.3% (p <0.0001). Adjusted BP response was significantly associated with age and baseline systolic and diastolic BP (p <0.0001). Whereas the decrease in systolic BP was more pronounced in younger patients, the opposite was observed for diastolic BP decrease. Diastolic BP response was also significantly associated with race. Specifically, the adjusted diastolic BP decrease was significantly smaller in Hispanics and blacks than whites (p = 0.0032 and p = 0.0069, respectively). However, Hispanics achieved a decrease in systolic BP and an increase in BP control similar to the other ethnic groups. There was no genetic association between AGTR1 1166A→C genotype and BP response. In conclusion, trandolapril add-on therapy was effective in increasing BP control, with age and baseline BP associated with both systolic and diastolic BP response. Race was associated with diastolic BP response, although the difference is likely not to be clinically significant and AGTR1 genotype was not associated with BP response.We assessed factors associated with the response to add-on therapy with the angiotensinconverting enzyme (ACE) inhibitor trandolapril, including race/ethnicity, angiotensin II type 1 receptor (AGTR1 MethodsThe INVEST rationale, design, inclusion and exclusion criteria, treatment strategies, and main results were published in detail elsewhere. Briefly, after an extensive cardiovascular history and physical examination, patients were randomly assigned to either a verapamil sustained release (SR)-trandolapril-or atenolol-hydrochlorothiazide-based antihypertensive strategy. Patients were evaluated every 6 weeks for the first 6 months and then biannually for ≥2 years to assess blood pressure (BP) and adverse outcomes. The detailed BP measurement method was published previously. 1,2 The INVEST on-line data system provided detailed tracking of study medication prescriptions. 3 From 1997 to 2003, follow-up of 61,835 patient-years was accumulated, and each strategy provided excellent BP control (>70% of patients achieved BP <140/90 mm Hg) without differences in BPs between strategies. The strategies...

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Blood pressure control and cardiovascular outcomes in high-risk Hispanic patients—Findings From the International Verapamil SR/Trandolapril Study (INVEST)

Cited by 65 publications

References 33 publications

Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension

Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension

Blood Pressure Control in Hispanics in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Factors Influencing Blood Pressure Response to Trandolapril Add-On Therapy in Patients Taking Verapamil SR (from the International Verapamil SR/Trandolapril [INVEST] Study)

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