Differences between blood-pressure-lowering drugs

Two papers published in this issue of The Lancet add to the existing evidence about the comparative effects of commonly used antihypertensive regimens. The INSIGHT and NORDIL trials each compared outcomes among patients assigned treatment with regimens based on calcium antagonists (nifedipine GITS a... Full description

Two papers published in this issue of The Lancet add to the existing evidence about the comparative effects of commonly used antihypertensive regimens. The INSIGHT and NORDIL trials each compared outcomes among patients assigned treatment with regimens based on calcium antagonists (nifedipine GITS and diltiazem, respectively) with outcomes among patients assigned a diuretic-based or beta-blocker-based regimen. Neither study found clear evidence of any difference in the frequencies of the pre-specified primary outcomes (combinations of major cardiovascular events), although both studies observed some differences in cause-specific outcomes. In NORDIL, there was a marginally significant lower risk of stroke with diltiazembased therapy (despite a lesser reduction in blood pressure), but there was no clear evidence of a difference in stroke risk in INSIGHT. Conversely, in INSIGHT, there was a marginally significant excess of heart failure with nifedipine-based treatment, but in NORDIL there was no clear evidence of a difference in heart-failure risk. Furthermore, although fatal myocardial infarctions were commoner with nifedipine-based treatment than with diuretic-based treatment in INSIGHT, in neither study was there a clear difference in total number of major CHD events, although the confidence intervals were wide.