this is a randomised trial of the effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular mortality and morbidity in hypertension
randomised, blinded, controlled trial; 4.5 years mean follow-up
patients:
10, 881 patients aged 50-69 years (extended to 74 years during the study) with a diastolic blood pressure >= 100 mmHg on 2 occasions; mean age of patients was 60 years old and 51% of patients were women
intervention:
allocated to treatments with diltiazem (n=5410) or diuretics or beta-blockers, or both (n=5471)
the treatment regimen for the diltiazem group was intensified if hypertension persisted with step-wise addition of ACE inhibitor, beta-blocker or an alpha blocker, and any other antihypertensive drug
in the non-diltiazem group treatment was started with a beta-blocker or diuretic. If necessary there was the stepped addition of the other drug, an ACE inhibitor or alpha-blocker, and any other antihypertensive drug (except a calcium antagonist)
outcome measures used were blood pressure and combined fatal and non-fatal stroke, fatal and non-fatal myocardial infarction (MI) and other CV death
results/conclusions:
diltiazem was as effective as diuretics, beta-blockers or both in the prevention of the combined end-point of stroke, myocardial infarction, and other cardiovascular death
in patients remaining in the study >= 24 months the reduction in systolic BP (but not diastolic BP) were smaller in the diltiazem group than in the diuretics and beta-blocker group (20/19 vs 23/19 mmHg, p<0.001)
Reference:
(1) Hansson L et al, for the NORDIL Study Group. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet, 356, 359-65.
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