How will INVEST and other hypertension trials change clinical practice?

Abstract

Three large, ongoing, international clinical trials will greatly improve our understanding of hypertension management. The trials, which include the INternational VErapamil SR/trandolapril STudy (INVEST), the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), and the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) trial, enrolled a combined total of 81,649 patients over a 7-year period from 18 different countries in North America, South America, Europe, and Australia-Asia. The mean age of all subjects was 66 years, and the mean body mass index (BMI) was 29.5. In addition, 30% of all patients had diabetes and 43% had documented coronary artery disease (CAD). In INVEST, 100% of enrolled patients had documented CAD and 27% had diabetes. Of patients treated for 12 months in INVEST, a systolic blood pressure (SBP) <140 mmHg was achieved by 70% of nondiabetics, and 66% of patients with diabetes achieved that level. Of all the patients enrolled in the three trials, 38% were smokers, 25% had a history of myocardial infarction (MI) or stroke, and 52% had a history of dyslipidemia. Although these clinical trials are likely to influence treatment guidelines, they may not affect the way medicine is practiced. A survey of primary care physicians found that 41% had not heard of or were not familiar with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines. The JNC VI and European guidelines provide management strategies based on severity of coronary risk factors, target organ damage, and blood pressure levels. Primary care physicians have a responsibility to be educated about risk stratification, goals of treatment based on risk, and management strategies for hypertension from available treatment guidelines.