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INternational VErapamil SR Trandolapril STudy

Phase 4
50 Years
Not Enrolling
Hypertension, Coronary Artery Disease

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Trial Information

INternational VErapamil SR Trandolapril STudy

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.

Inclusion Criteria:

- Male or female

- Age 50 to no upper limit

- 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)

- Documented CAD (e.g., classic angina pectoris (stable angina pectoris; Heberden
angina pectoris), myocardial infarction three or more months ago, abnormal coronary
angiography, or concordant abnormalities on two different types of stress tests)

- Willingness to sign informed consent

Exclusion Criteria:

- Unstable angina, angioplasty, coronary artery bypass graft surgery (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.

- Use of a ß-blocker within past two weeks

- Patients without a pacemaker and any of the following:

- Sinus bradycardia (< 50 beats/min.)

- Sick sinus syndrome

- Atrioventricular (AV)-block of more than 1st degree

- Documented contraindication to verapamil; documented contraindication to both
atenolol and hydrochlorothiazide

- Atrial fibrillation/flutter with Wolff-Parkinson-White (WPW)-Syndrome

- Severe heart failure (New York Heart Association [NYHA] IV).

- 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.

- Patients with psychiatric, cognitive, or social (e.g., alcoholism, etc.) conditions
that would interfere with giving consent or cooperating or remaining available for
follow-up for two years.

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

First occurrence of death or nonfatal myocardial infarction (MI) or nonfatal stroke

Principal Investigator

Carl J Pepine, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

University of Florida


United States: Institutional Review Board

Study ID:




Start Date:

September 1997

Completion Date:

February 2003

Related Keywords:

  • Hypertension
  • Coronary Artery Disease
  • Hypertension
  • Coronary Artery Disease
  • Diabetes
  • Verapamil SR
  • Trandolapril
  • Atenolol
  • HCTZ
  • Coronary Artery Disease
  • Myocardial Ischemia
  • Coronary Disease
  • Hypertension



University of Florida Gainesville, Florida  32610-0277