Controlled-onset extended-release verapamil was not equivalent to standard therapy for preventing cardiovascular disease: COMMENTARY

Rosenberg, Eric; Davidson, Richard
November 2003
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, p74
Academic Journal
The primary aim of controlled onset verapamil investigation of cardiovascular end points (COVINCE) was important to determine whether extended-release verapamil was equivalent to atenolol and hydrochlorothiazide for preventing CVD events. The investigators had planned to evaluate 16000 patients over 5 years, however, the study closed after only 3 years of follow-up for commercial reasons. As a result of the reduced study length as well as an unexpectedly large dropout rate, the study has suffered from the crucial flaw of having insufficient statistical power to detect significant differences between treatment groups. As in other recent trials, many patients in COVINCE were not controlled with monotherapy and required additional treatment. Attention to a standardized protocol for adding medications would strengthen future trials of anti-hypertensive treatment. Definite conclusions regarding the comparative rate of overall CVD-related events and adverse events among treatment groups cannot be drawn from the results of this abbreviated clinical trial. This study is consistent with others in providing no evidence that any anti-hypertensive agent is superior to diuretic therapy for initial treatment of hypertension. In addition, the finding of slightly increased bleeding risk and greater cost supports the argument that calcium channel blockers are not ideal as first-line choices for hypertension treatment.


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