OBJECTIVES: We sought to determine predictors for adverse outcomes in hypertensive patients with coronary artery disease(CAD). BACKGROUND: Factors leading to adverse outcomes in hypertensive patients with CAD are poorly understood. The INternational VErapamil- tran- dolapril STudy(INVEST)compared outcomes in hypertensive patients with CAD that were assigned randomly to either a verapamil sustained- release(SR)or an atenolol- based strategy for blood pressure(BP)control. Trandolapril and hydrochlorothiazide were used as added agents. During follow- up(61,835 patient- years), BP control and the primary outcome(death, nonfatal myocardial infarction, and nonfatal stroke)were not different between strategies. METHODS: We investigated risk for adverse outcome associated with baseline factors, follow- up BP, and drug treatments using Cox modeling. RESULTS: Previous heart failure(adjusted hazard ratio [HR] 1.96), as well as diabetes(HR 1.77), increased age(HR 1.63), U.S. residency(HR 1.61), renal impairment(HR 1.50), stroke/transient ischemic attack(HR 1.43), smoking(HR 1.41), myocardial infarction(HR 1.34), peripheral vascular disease(HR 1.27), and revascularization(HR 1.15) predicted increased risk. Follow- up systolic BP< 140 mm Hg or diastolic BP< 90 mm Hg(HRs 0.82 or 0.70, respectively) and trandolapril with verapamil SR(HRs 0.78 and 0.79) were associated with reduced risk. CONCLUSIONS: In hypertensive patients with CAD, increased risk for adverse outcomes was associated with conditions related to the severity of CAD and diminished left ventricular function. Lower follow- up BP and addition of trandolapril to verapamil SR each were associated with reduced risk. OBJECTIVES: We sought to determine predictors of adverse outcomes in hypertensive patients with CAD are poorly understood. The INternational VErapamil-tran- dolapril STudy (INVEST) in hypertensive patients with CAD that were assigned randomly to either a verapamil sustained-release (SR) or an atenolol-based strategy for blood pressure (BP) control. Trandolapril and hydrochlorothiazide were used as added agents. During follow-up (61,835 patient- METHODS: We investigated risk for adverse outcome associated with baseline factors, follow-up BP, and drug treatments using Cox modeling RESULTS: Previous heart failure (adjusted hazard ratio [HR] 1.96), as well as diabetes (HR 1.77), increased age (HR 1.63), US residency (HR 1.61), r enal impairment (HR 1.50), stroke / transient ischemic attack (HR 1.43), smoking (HR 1.41), myocardial infarction (HR 1.34), peripheral vascular disease (HR 1.27), and revascularization up systolic BP <140 mm Hg or diastolic BP <90 mm Hg (HRs 0.82 or 0.70, respectively) and trandolapril with verapamil SR (HRs 0.78 and 0.79) were associated with reduced risk. CONCLUSIONS: In hypertensive patients with CAD, increased risk for adverse outcomes was associated with conditions related to the severity of CAD and diminished left ventricular function. Lower follow-up BP and addition of trandolapril to verapamil SR each were associated with reduced risk.