Because blood pressure affects the heart, blood vessels, kidneys, and the entire body, it is important to keep it as normal as possible. There are several different ways to control blood pressure and to prevent or limit the development of heart disease due to high blood pressure. The purpose of this study is to compare two treatments to see how well they work and the difference in their side effects. One treatment includes the use of a calcium antagonist drug (Isoptin SR or Verapamil SR). The other treatment excludes the calcium antagonist and may include a noncalcium antagonist drug called a beta blocker (Tenormin or Atenolol). Both treatments may also include medication called ACE inhibitors and water pills. None of the drugs in this study are experimental, they are all approved by the Food and Drug Administration (FDA).

Condition	Intervention	Phase
Hypertension Coronary Artery Disease	Drug: Verapamil SR/Trandolapril/HCTZ vs Atenolol/HCTZ/Trandolapril	Phase IV

Further Study Details: 

Primary Outcomes: First ocurrence of Death or Nonfatal MI or Nonfatal Stroke
Secondary Outcomes: Death; Nonfatal MI; Nonfatal Stroke; Newly Diagnosed Diabetes; BP Control; Cancer; GI Bleeding; Alzheimer''''s Disease; Parkinson''''s Disease; CV Hospitalizations; Quality of Life; Compliance
Expected Total Enrollment:  22000

INVEST is an investigator initiated international, prospective, randomized study comparing two pharmacotherapy strategies to control hypertension in ambulatory patients with coronary artery disease (CAD). One strategy, the calcium antagonist care strategy, centers on a calcium antagonist (verapamil SR) followed by addition of an ACE inhibitor (trandolapril) and then diuretic (hydrochlorothiazide) as needed to achieve target blood pressures (BP). The other strategy, the non-calcium antagonist care strategy, uses a beta-blocker (atenolol) followed by addition of low-dose diuretic and then an ACE inhibitor (trandolapril) as needed to reach target BP. In either strategy additional drugs can be added provided the calcium antagonist is retained in the calcium antagonist care strategy and calcium antagonists are omitted in the non-calcium antagonist care strategy.

The study is organized into 15 international regions with about 1,500 study investigators randomizing approximately 22,000 patients who will be treated for at least two years. The primary response variable is the occurrence of adverse outcome, defined as any of the following events: all cause mortality, nonfatal MI or nonfatal stroke. A number of secondary response variables, including newly diagnosed diabetes will also be evaluated.

The primary objective of this trial is to examine the hypothesis that the risk for adverse outcomes (all cause mortality, nonfatal MI or nonfatal stroke) in hypertensive patients with CAD is at least equivalent during treatment of hypertension with a calcium antagonist strategy when compared with a non-calcium antagonist strategy.

Unique features of INVEST are, in addition to its size and international scope, its design to mimic standard clinical practice and its all electronic online data entry, drug distribution system, study management system, and electronic physician compensation. This system will permit the entire trial to be conducted via the Internet. This design is believed to be a forerunner of clinical trials research for the future.

Ages Eligible for Study:  50 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

1. Male or female
2. Age 50 to no upper limit
3. Hypertension documented according to the 6th report of the Joint National Committee on Detection and Evaluation of the treatment of high BP (JNC VI) and the need for drug therapy (previously documented hypertension in patients currently taking antihypertensive agents is acceptable)
4. Documented CAD (e.g., classic angina pectoris (stable angina pectoris; Heberden angina pectoris), myocardial infarction three of more months ago, abnormal coronary angiography, or concordant abnormalities on two different types of stress tests)
5. Willingness to sign informed consent

Exclusion Criteria:

1. Unstable angina, angioplasty, CABG or stroke within one month. Patients taking beta blockers after myocardial infarction are excluded if study enrollment is planned within 12 months of myocardial infarction. No time limitation if not taking beta-blocker.
2. Use of a ß-blocker within past two weeks

3. Patients without a pacemaker and any of the following:

   Sinus bradycardia (< 50 beats/min.) Sick sinus syndrome AV-block of more than 1st degree

4. Documented contraindication to verapamil;documented contraindication to both atenolol and hydrochlorothiazide
5. Atrial fibrillation/flutter with WPW-Syndrome
6. Severe heart failure (NYHA IV).
7. Concomitant illnesses (e.g., severe renal failure [Serum creatinine ≥4.0 mg/dl], severe hepatic failure or known cirrhosis, etc.) which may affect outcome variables or where life expectancy is two years or less or which are likely to require frequent hospitalizations and/or treatment adjustments.
8. Patients with psychiatric, cognitive, or social (e.g., alcoholism, etc.) conditions that would interfere with giving consent, cooperating or remaining available for follow-up for two years.

Florida
      University of Florida, Gainesville,  Florida,  32610-0277,  United States

Study chairs or principal investigators

Carl J Pepine, MD,  Principal Investigator,  University of Florida   

Study ID Numbers:  INVEST
Last Updated:  August 22, 2005
Record first received:  August 22, 2005
ClinicalTrials.gov Identifier:  NCT00133692
Health Authority: United States: Institutional Review Board
ClinicalTrials.gov processed this record on 2005-08-23