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Randomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study

Calcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a non-dihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, β-blockers, or both on cardiovascular... Full description

Journal Title: The Lancet (British edition) 2000, Vol.356 (9227), p.359-365
Main Author: Hansson, Lennart
Other Authors: Hedner, Thomas , Lund-Johansen, Per , Kjeldsen, Sverre Erik , Lindholm, Lars H , Syvertsen, Jan Otto , Lanke, Jan , de Faire, Ulf , Dahlöf, Björn , Karlberg, Bengt E
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Randomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study
format: Article
creator:
  • Hansson, Lennart
  • Hedner, Thomas
  • Lund-Johansen, Per
  • Kjeldsen, Sverre Erik
  • Lindholm, Lars H
  • Syvertsen, Jan Otto
  • Lanke, Jan
  • de Faire, Ulf
  • Dahlöf, Björn
  • Karlberg, Bengt E
subjects:
  • Abridged Index Medicus
  • Adrenergic beta-Antagonists - therapeutic use
  • Aged
  • Antihypertensive agents
  • Antihypertensive Agents - therapeutic use
  • Biological and medical sciences
  • Calcium Channel Blockers - therapeutic use
  • Cardiovascular Diseases - mortality
  • Cardiovascular Diseases - prevention & control
  • Cardiovascular system
  • Diltiazem - therapeutic use
  • Diuretics - therapeutic use
  • Female
  • Humans
  • Hypertension - complications
  • Hypertension - drug therapy
  • Life Tables
  • Male
  • Medical sciences
  • Medicin och hälsovetenskap
  • Middle Aged
  • Myocardial Infarction - mortality
  • Myocardial Infarction - prevention & control
  • Natural Sciences
  • Naturvetenskap
  • Pharmacology. Drug treatments
  • Prospective Studies
  • Risk Factors
  • Single-Blind Method
  • Stroke - mortality
  • Stroke - prevention & control
ispartof: The Lancet (British edition), 2000, Vol.356 (9227), p.359-365
description: Calcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a non-dihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, β-blockers, or both on cardiovascular morbidity and mortality in hypertensive patients. 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, β-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. Systolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and β-blocker groups (reduction 20·3/18·7 vs 23·3/18·7 mm Hg; difference in systolic reduction p
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
url: Link


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titleRandomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study
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creatorHansson, Lennart ; Hedner, Thomas ; Lund-Johansen, Per ; Kjeldsen, Sverre Erik ; Lindholm, Lars H ; Syvertsen, Jan Otto ; Lanke, Jan ; de Faire, Ulf ; Dahlöf, Björn ; Karlberg, Bengt E
creatorcontribHansson, Lennart ; Hedner, Thomas ; Lund-Johansen, Per ; Kjeldsen, Sverre Erik ; Lindholm, Lars H ; Syvertsen, Jan Otto ; Lanke, Jan ; de Faire, Ulf ; Dahlöf, Björn ; Karlberg, Bengt E ; for the NORDIL Study Group
descriptionCalcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a non-dihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, β-blockers, or both on cardiovascular morbidity and mortality in hypertensive patients. 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, β-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. Systolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and β-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 β-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 β-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). Diltiazem was as effective as treatment based on diuretics, β-blockers, or both in preventing the combined primary endpoint of all stroke, myocardial infarction, and other cardiovascular death.
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subjectAbridged Index Medicus ; Adrenergic beta-Antagonists - therapeutic use ; Aged ; Antihypertensive agents ; Antihypertensive Agents - therapeutic use ; Biological and medical sciences ; Calcium Channel Blockers - therapeutic use ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - prevention & control ; Cardiovascular system ; Diltiazem - therapeutic use ; Diuretics - therapeutic use ; Female ; Humans ; Hypertension - complications ; Hypertension - drug therapy ; Life Tables ; Male ; Medical sciences ; Medicin och hälsovetenskap ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - prevention & control ; Natural Sciences ; Naturvetenskap ; Pharmacology. Drug treatments ; Prospective Studies ; Risk Factors ; Single-Blind Method ; Stroke - mortality ; Stroke - prevention & control
ispartofThe Lancet (British edition), 2000, Vol.356 (9227), p.359-365
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1Hedner, Thomas
2Lund-Johansen, Per
3Kjeldsen, Sverre Erik
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5Syvertsen, Jan Otto
6Lanke, Jan
7de Faire, Ulf
8Dahlöf, Björn
9Karlberg, Bengt E
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1The Lancet (British edition)
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descriptionCalcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a non-dihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, β-blockers, or both on cardiovascular morbidity and mortality in hypertensive patients. 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, β-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. Systolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and β-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 β-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 β-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). Diltiazem was as effective as treatment based on diuretics, β-blockers, or both in preventing the combined primary endpoint of all stroke, myocardial infarction, and other cardiovascular death.
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1Adrenergic beta-Antagonists - therapeutic use
2Aged
3Antihypertensive agents
4Antihypertensive Agents - therapeutic use
5Biological and medical sciences
6Calcium Channel Blockers - therapeutic use
7Cardiovascular Diseases - mortality
8Cardiovascular Diseases - prevention & control
9Cardiovascular system
10Diltiazem - therapeutic use
11Diuretics - therapeutic use
12Female
13Humans
14Hypertension - complications
15Hypertension - drug therapy
16Life Tables
17Male
18Medical sciences
19Medicin och hälsovetenskap
20Middle Aged
21Myocardial Infarction - mortality
22Myocardial Infarction - prevention & control
23Natural Sciences
24Naturvetenskap
25Pharmacology. Drug treatments
26Prospective Studies
27Risk Factors
28Single-Blind Method
29Stroke - mortality
30Stroke - prevention & control
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2Lund-Johansen, Per
3Kjeldsen, Sverre Erik
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8Dahlöf, Björn
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titleRandomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study
authorHansson, Lennart ; Hedner, Thomas ; Lund-Johansen, Per ; Kjeldsen, Sverre Erik ; Lindholm, Lars H ; Syvertsen, Jan Otto ; Lanke, Jan ; de Faire, Ulf ; Dahlöf, Björn ; Karlberg, Bengt E
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6Calcium Channel Blockers - therapeutic use
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21Myocardial Infarction - mortality
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29Stroke - mortality
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abstractCalcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a non-dihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, β-blockers, or both on cardiovascular morbidity and mortality in hypertensive patients. 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, β-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. Systolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and β-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 β-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 β-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). Diltiazem was as effective as treatment based on diuretics, β-blockers, or both in preventing the combined primary endpoint of all stroke, myocardial infarction, and other cardiovascular death.
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pmid10972367
doi10.1016/S0140-6736(00)02526-5