Hypertension: diltiazem was as effective as beta-blockers or diuretics are preventing death, stroke or myocardial infarction

Clinical bottom line (level 1b)

  1. Patients with untreated hypertension who took diltiazem compared with beta-blockers or diuretics were not more likely to have a stroke, myocardial infarction or die from a cardiovascular cause.
  2. Patients on diltiazem were more likely to have a headache (NNH = 36 at 4.5 years) but less likely to develop impotence (NNT = at 4.5 years) .
Hansson et al: Lancet 2000; 356 : 359-365
Expires August 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 1032 health centres, Norway and Sweden

10881 patients (aged mean 60, 51% male) with previously untreated hypertension (diastolic bp > 100 mmHg on two or more occasions)

Excluded if
  • aged < 50, or > 74

    Control Group: (n = 5471, 5471 analysed): beta-blocker or diuretic or both
    Experimental Group: (n = , analysed): diltiazem 180 to 360 mg
    All patients could receive additional antihypertensive treatment in several steps to lower diastolic blood pressure to < 90 mmHg.
    99.5% followed for 4.5 years
    Outcome notes:
    • clinical event : stroke, myocardial infarction, cardiovascular death

    The evidence

    Outcome Time to outcome CER EER RRR
    (95% CI)    		 ARR
    (95% CI)    		 NNT
    (95% CI)
    clinical event weeks 400
    (7.31%)    		 403
    (7.45%)    		 -2%
    (-16% to 11%)    		 -0.14%
    (-1.12% to 0.845%)    		 -730
    (NNT = 89 to infinity;
    NNH = 120 to infinity)
    headache 4.5 years 311
    (5.68%)    		 458
    (8.47%)    		 -49%
    (-71% to -30%)    		 -2.78%
    (-3.74% to -1.82%)    		 -36
    (-55 to -27)
    impotence 4.5 years 202
    (3.69%)    		 126
    (2.33%)    		 37%
    (21% to 49%)    		 1.36%
    (0.72% to 2.00%)    		 73
    (50 to 140)

    Citation

    1. Hansson L, Hedner T, Lund-Johansen P, et al: 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 2000; 356 : 359-365
    Search Terms: from ACP Journal Club
    Contributor: Chris Ball, August 2001
    Reviewer:

    Clinical Question.
    Patient untreated hypertension
    Intervention or Exposure diltiazem
    Comparison beta-blockers, diuretics
    Outcome death, stroke, myocardial infarction, adverse effects