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Long acting nifedipine was as effective as hydrochlorothiazide plus amiloride for reducing mortality and morbidity in hypertension
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 QUESTION: In patients with hypertension who are at high risk for cardiovascular (CV) events, is long acting nifedipine, a calcium channel blocker, as effective as co-amilozide (hydrochlorothiazide and amiloride) for preventing CV and cerebrovascular mortality and morbidity?

Design

Randomised (allocation concealed*), blinded (patients, physicians, and outcome assessors),* placebo controlled trial with ≥3 years follow up (Intervention as a Goal in Hypertension Treatment [INSIGHT] trial).

Setting

703 centres in 8 countries in western Europe and Israel.

Patients

7343 patients with hypertension were enrolled, 6575 were randomised, and 6321 (mean age 65 y, 54% women) were studied after exclusion of 9 centres because of protocol violations. Patients were required to have ≥1 additional CV risk factor (hypercholesterolaemia, smoking, family history of early myocardial infarction [MI], left ventricular hypertrophy or strain, coronary artery disease, or peripheral vascular disease). Follow up was 94%.

Intervention

3157 patients were analysed in the long acting nifedipine group (30 mg/d), and 3164 were in the co-amilozide group (hydrochlorothiazide, 25 mg/d, and amiloride, 2.5 mg/d). If hypertension persisted, the regimen was …

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