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Rhonda M. Cooper-DeHoff, Yan Gong, Eileen M. Handberg, Anthony A. Bavry, Scott J. Denardo, George L. Bakris and Car PowerPoint Presentation
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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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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

disclosures
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
background
Background

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

objective
Objective

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

hypothesis
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

invest trial design
INVEST Trial Design

Pepine et al. JAMA. 2003:290:2805-2816

results flow diagram
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

results antihypertensive drug use
Results – Antihypertensive Drug Use

Mean Number of Study + Nonstudy Antihypertenisve Drugs

results outcomes us cohort
Results: Outcomes – US Cohort

Adj. HR 1.15, 95% CI 1.01-1.32, p=0.036

4

2

0

12

10

8

6