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Diltiazem Equal To Thiazide Diuretic And Beta-blocker For Stroke Prevention
A DGReview of :"Randomised trial of effects of calcium antagonists compared with diuretics and ß-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study"
Lancet
07/28/2000
By Bruce Yates
Diltiazem is as effective as diuretics, beta-blockers, or both in preventing stroke, myocardial infarction or death, a large scale Scandinavian trial shows.
A total of 10,881 patients, aged 50 to 74, with a diastolic pressure of 100 mm Hg or higher, were enrolled in the prospective, randomised, open and blind end point study at health centers in Norway and Sweden.
Patients were randomly assigned to receive diltiazem -- a non-dihydropyridine calcium antagonist -- a diuretic, a beta-blocker or a combination of a diuretic and a beta-blocker.
Effectiveness of diltiazem in reducing cardiovascular morbidity or mortality was unclear before the trial. Combined primary endpoints were fatal, or non-fatal, stroke, myocardial infarction and other cardiovascular death.
Systolic and diastolic pressures were lowered effectively by all three drugs. There was a primary end point in 403 patients in the diltiazem group and 400 in the diuretic and beta block groups. There were fatal and non-fatal strokes in 159 patients receiving diltiazem and in 196 patients in the diuretics and beta-blocker groups. There were fatal and non-fatal infarctions in 193 patients in the diltiazem group and in 157 patients in the diuretics and beta-blocker groups.
Both treatments were equally well tolerated. Leg oedema and flushing, common side-effects of dihydropyridine-derived calcium antagonists, were not among the 12 most common adverse events in the diltiazem group.
"Antihypertensive treatment with a diltiazem-based regimen did not affect total mortality or the sum of major cardiovascular events differently from a thiazide diuretic and beta-blocker regimen," researchers conclude.
"Randomised trial of effects of calcium antagonists compared with diuretics and ß-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study"
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