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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
Univ Uppsala, Dept Publ Hlth & Social Sci, S-75125 Uppsala, Sweden Sahlgrens Univ Hosp, Dept Clin Pharmacol, Gothenburg, Sweden Haukeland Univ Hosp, Dept Cardiol, N-5021 Bergen, Norway Ulleval Univ Hosp, Dept Cardiol, Oslo, Norway Umea Univ Hosp, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden Univ Lund, Dept Stat, Lund, Sweden Varna Med Ctr, Moss, Norway Karolinska Univ Hosp, Dept Med, Stockholm, Sweden Ostra Hosp, Dept Med, S-41685 Gothenburg, Sweden Linkoping Univ Hosp, Dept Endocrinol, S-58185 Linkoping, Sweden.
Univ Uppsala, Dept Publ Hlth & Social Sci, S-75125 Uppsala, Sweden Sahlgrens Univ Hosp, Dept Clin Pharmacol, Gothenburg, Sweden Haukeland Univ Hosp, Dept Cardiol, N-5021 Bergen, Norway Ulleval Univ Hosp, Dept Cardiol, Oslo, Norway Umea Univ Hosp, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden Univ Lund, Dept Stat, Lund, Sweden Varna Med Ctr, Moss, Norway Karolinska Univ Hosp, Dept Med, Stockholm, Sweden Ostra Hosp, Dept Med, S-41685 Gothenburg, Sweden Linkoping Univ Hosp, Dept Endocrinol, S-58185 Linkoping, Sweden.
Univ Uppsala, Dept Publ Hlth & Social Sci, S-75125 Uppsala, Sweden Sahlgrens Univ Hosp, Dept Clin Pharmacol, Gothenburg, Sweden Haukeland Univ Hosp, Dept Cardiol, N-5021 Bergen, Norway Ulleval Univ Hosp, Dept Cardiol, Oslo, Norway Umea Univ Hosp, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden Univ Lund, Dept Stat, Lund, Sweden Varna Med Ctr, Moss, Norway Karolinska Univ Hosp, Dept Med, Stockholm, Sweden Ostra Hosp, Dept Med, S-41685 Gothenburg, Sweden Linkoping Univ Hosp, Dept Endocrinol, S-58185 Linkoping, Sweden.
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2000 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 356, no 9227, 359-365 p.Article in journal (Refereed) Published
Abstract [en]

Background Calcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a nondihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, beta-blockers, or both on cardiovascular morbidity and mortality in hypertensive patients. Methods In a prospective, randomised, open, blinded endpoint study, we enrolled 10 881 patients, aged 50-74 years, at health centres in Norway and Sweden, who had diastolic blood pressure of 100 mm Hg or more. We randomly assigned patients diltiazem, or diuretics, beta-blockers, or both. The combined primary endpoint was fatal and non-fatal stroke, myocardial infarction, and other cardiovascular death. Analysis was done by intention to treat. Findings Systolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and beta-blocker groups (reduction 20.3/18.7 vs 23.3/18.7 mm Hg, difference in systolic reduction p<0.001). A primary endpoint occurred in 403 patients in the diltiazem group and in 400 in the diuretic and beta-blocker group (16.6 vs 16.2 events per 1000 patient-years, relative risk 1.00 [95% CI 0.87-1.15], p=0.97). Fatal and non-fatal stroke occurred in 159 patients in the diltiazem group and in 196 in the diuretic and beta-blocker group (6.4 vs 7.9 events per 1000 patient-years, 0.80 [0.65-0.99], p=0.04) and fatal and non-fatal myocardial infarction in 183 and 157 patients (7.4 vs 6.3 events per 1000 patient-years, 1.16 [0.94-1.44], p=0.17). Interpretation Diltiazem was as effective as treatment based on diuretics, beta-blockers, or both in preventing the combined primary endpoint of all stroke, myocardial infarction, and other cardiovascular death.

Place, publisher, year, edition, pages
2000. Vol. 356, no 9227, 359-365 p.
National Category
Natural Sciences
Identifiers
URN: urn:nbn:se:liu:diva-49657OAI: oai:DiVA.org:liu-49657DiVA: diva2:270553
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12

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