NEW YORK (Reuters Health) – In hypertensive patients with a prior MI, a treatment strategy based on sustained release verapamil is comparable to one based on atenolol in preventing cardiovascular events, but improves subjective well-being and may cut the risks of angina and stroke, new research suggests.

Although beta-blockers have been shown to reduce mortality in prior MI patients by up to 40%, these agents are often poorly tolerated, limiting compliance, Dr. Franz H. Messerli and co-researchers report in the American Heart Journal for August. Treatment based on calcium channel blockers may enhance compliance, but it was unclear if outcomes were as good as seen with beta-blocker-based strategies.

The researchers addressed this topic by analyzing data from 7218 hypertensive patients with prior MI who were enrolled in the International Verapamil SR-Trandolapril (INVEST) substudy in which they were randomized to treatment based on verapamil SR or atenolol. The primary endpoint was the composite of all-cause mortality, nonfatal MI, or nonfatal stroke.

During a mean follow-up period of 2.8 years, the percentage of patients in each group who reached the primary endpoint was comparable at about 14%. Each approach also provided similar blood pressure control, Dr. Messerli, from Columbia University College of Physicians and Surgeons in New York, and colleagues report.

Further analysis revealed that while the strategies were similar in reducing the risk of death and MI, the verapamil SR-based approach may have offered an advantage in preventing stroke. The nonfatal stroke rate in the verapamil group was 1.4% compared with 2.0% in the atenolol group; the difference fell just short of statistical significance (p = 0.06).

The incidence of angina pectoris was also lower with the verapamil-based strategy than with atenolol-based approach: 12.0% vs. 14.3%. Once again, however, the difference was not quite statistically significant (p = 0.07).

By contrast, the verapamil-based approach did offer a significant improvement in self-reported well-being. With this strategy, 82.3% of patients reported good or excellent well-being compared with just 78.0% of patients given atenolol (p = 0.02).

“In hypertensive patients with a prior MI unable to tolerate a beta-blocker, a verapamil SR-based strategy may be an acceptable alternative for the secondary prevention of cardiovascular events,” Dr. Messerli’s team concludes.

Reference:
Am Heart J 2008;156:241-247.