INVEST: Systolic BP control not associated with improved CV outcomes in patients with CAD, diabetes

New data from the INVEST study suggested that tight control of systolic blood pressure in patients with diabetes and coronary artery disease was not linked with improved cardiovascular outcomes compared with usual control.

The observational group analysis included 6,400 of the 22,576 participants in the International Verapamil SR-Trandolapril study (INVEST). All were aged 50 years and older and had diabetes and CAD. Participants were recruited between September 1997 and December 2000 from 862 sites in 14 countries.

First-line treatment included either a calcium antagonist or beta-blocker followed by angiotensin-converting enzyme inhibitor, a diuretic or both to achieve systolic BP <130 mm Hg and diastolic BP <85 mm Hg. Follow-up lasted through March 2003 with an extended follow-up through August 2008 for U.S. participants via the National Death Index.

Of the patients who experienced a primary outcome event (all-cause death, nonfatal myocardial infarction or nonfatal stroke), 286 patients maintained tight control (12.7%; <130 mm Hg), 249 had usual control (12.6%; 130 mm Hg to140 mm Hg) and 431 had uncontrolled systolic BP (19.8%; >140 mm Hg). The adjusted HR for CV event rate for patients in the usual control group vs. uncontrolled group was 1.46 (95% CI, 1.25-1.71); for tight control vs. usual control it was 1.11 (95% CI, 0.93-1.32).

“At this time, there is no compelling evidence to indicate that lowering systolic BP below 130 mm Hg is beneficial for patients with diabetes,” the researchers concluded. “Thus, emphasis should be placed on maintaining systolic BP between 130 mm Hg and 139 mm Hg while focusing on weight loss, healthful eating and other manifestations of CV morbidity to further reduce long-term CV risk.”

Cooper-DeHoff RM. JAMA. 2010;304:61-68.

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