The International Verapamil SR-Trandolapril Study (INVEST), a randomized trial of 22,576 predominantly elderly patients with an average 2.7-year follow-up, compared a calcium antagonist-led strategy (verapamil SR plus trandolapril) with a beta-blocker-led strategy (atenolol plus hydrochlorothiazide) for hypertension treatment and prevention of cardiovascular outcomes in coronary artery disease patients. Patients received individualized dose and drug titration following a flexible, multi-drug, guideline-based treatment algorithm, with the objective of achieving optimal blood pressure (BP) control individualized for comorbidities (e.g., diabetes). The primary outcome (PO) was first occurrence of death (all-cause), nonfatal myocardial infarction or nonfatal stroke. The strategies resulted in significant and very similar BP reduction, with approximately 70% of patients in both strategies achieving BP control (<140/90 mmHg). Increasing number of office visits with BP in control was associated with reduced risk of the PO. Overall, there was no difference in the PO comparing the strategies; however, new-onset diabetes occurred more frequently in those assigned the atenolol strategy. This report summarizes findings from INVEST and puts them in perspective with our current state of knowledge derived from other large hypertension treatment trials. INVEST findings support that BP reduction is important for prevention of adverse cardiovascular morbidity and mortality, and selection of antihypertensive agents should be based on patient comorbidities and other risk factors (e.g., risk for diabetes) and not necessarily that any one drug be given to all.

PURPOSE: To assess the prevalence of spontaneous pulsations of the central retinal vein in eyes with chronic open-angle glaucoma versus normal eyes in the setting of a general ophthalmic practice. METHODS: The clinical observational case-series study included 167 eyes of 84 subjects with chronic open-angle glaucoma and 704 eyes (352 subjects) of a control group. The optic disc was ophthalmoscopically examined using a noncontact ophthalmoscopic lens at the slit lamp in medical mydriasis. RESULTS: Spontaneous pulsations of the central retinal vein were observed in significantly (P=0.005; odds ratio, 0.59; 95% confidence interval, 0.41-0.84) fewer eyes of the glaucoma group (107/167 or 64.1%+/-3.7%%) than in the eyes of the control group (530/704 or 75.3%+/-1.6%). In both groups, the presence of a spontaneous central retinal vein pulsation was statistically (P>0.10) independent of age, sex, refractive error, and intraocular pressure. CONCLUSIONS: As examined in a nonreferral ophthalmic practice, eyes with chronic open-angle glaucoma compared with normal eyes show a significantly lower frequency of detected spontaneous pulsations of the central retinal vein. Confirming previous hospital-based studies, the results suggest that assessment of the central retinal vessel pulsations, as part of an optic disc examination may clinically be useful for the diagnosis of glaucoma.

Aim To determine the relationship between resting heart rate (RHR) and adverse outcomes in coronary artery disease (CAD) patients treated for hypertension with different RHR-lowering strategies. Methods and results Time to adverse outcomes (death, non-fatal myocardial infarction, or non-fatal-stroke) and predictive values of baseline and follow-up RHR were assessed in INternational VErapamil-SR/trandolapril STudy (INVEST) patients randomized to either a verapamil-SR (Ve) or atenolol (At)-based strategy. Higher baseline and follow-up RHR were associated with increased adverse outcome risks, with a linear relationship for baseline RHR and J-shaped relationship for follow-up RHR. Although follow-up RHR was independently associated with adverse outcomes, it added less excess risk than baseline conditions such as heart failure and diabetes. The At strategy reduced RHR more than Ve (at 24 months, 69.2 vs. 72.8 beats/min; P < 0.001), yet adverse outcomes were similar [Ve 9.67%(rate 35/1000 patient-years) vs. At 9.88%(rate 36/1000 patient-years, confidence interval 0.90-1.06, P = 0.62)]. For the same RHR, men had a higher risk than women. Conclusion Among CAD patients with hypertension, RHR predicts adverse outcomes, and on-treatment RHR is more predictive than baseline RHR. A Ve strategy is less effective than an At strategy for lowering RHR but has a similar effect on adverse outcomes.

The purpose of this study is to assess the frequency of eyes with a spontaneous pulsation of the central retinal vein in the setting of a busy daily ophthalmic practice. The clinical observational case-series study included 690 eyes (345 subjects). The optic disc was ophthalmoscopically assessed using a non-contact ophthalmoscopic lens at the slit lamp. Out of the study population, 526 eyes (76.2%) of 265 (76.8%) subjects showed a detected spontaneous pulsation of the central retinal vein (prevalence rate: 76.2 +/- 1.6%[mean +/- standard error] per eye, and 76.8 +/- 2.3% per subject). In univariate analysis, the presence of a detected spontaneous central retinal vein pulsations was statistically associated with systolic systemic blood pressure (P = 0.04) and with the ocular perfusion pressure (P = 0.03). The results suggest that as examined in the setting of a busy daily ophthalmic practice, the central retinal vein was found to show a spontaneous pulsation in about 80% of the subjects.