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QUESTION: In middle aged patients with hypertension, is diltiazem, a non-dihydropyridine calcium antagonist, as effective as diuretics, β blockers, or both at preventing cardiovascular (CV) events?
Randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with mean follow up of 4.5 years (Nordic Diltiazem [NORDIL] study).
1032 primary healthcare centres in Norway and Sweden.
10 881 patients (mean age 60 y, 51% women) who had hypertension (diastolic blood pressure [BP] ≥100 mm Hg on 2 occasions) and were aged 50 to 69 years (extended to 74 y during the study). Follow up was >99%.
Patients were allocated to diltiazem (n=5410) or to diuretics or β blockers, or both (n=5471). If hypertension persisted, the regimen was intensified. Diltiazem was started at 180 to 360 mg/day, with stepped addition of an angiotensin converting enzyme (ACE) inhibitor, a diuretic or α blocker, and any other antihypertensive drug. In the other group, a thiazide diuretic or β blocker was started with stepped addition of the other drug, an ACE inhibitor or α …