Treatment of mild-to-moderate hypertension: comparison between a calcium-channel blocker and a potassium-sparing diuretic.
In a multicenter study, 61 patients, 18-70 years of age, with mild-to-moderate hypertension [diastolic blood pressure (DBP) 95/114] completed a 28-week treatment. After initial placebo washout, patients were randomly allocated either to diltiazem or hydrochlorothiazide/triamterene. At the end of 12 weeks, the patients continued on the same medication if their goal blood pressure achieved (DBP less than 90; or 10 mm Hg below baseline). If not, the alternate agent was added (either diltiazem + hydrochlorothiazide/triamterene or hydrochlorothiazide/triamterene + diltiazem). At the end of 28 weeks, the intent-to-treat analysis showed that 90% on diltiazem alone, 73.7% on hydrochlorothiazide/triamterene alone, 71.4% on (diltiazem + hydrochlorothiazide/triamterene), and 57.1% on (hydrochlorothiazide/triamterene + diltiazem) achieved goal BP. End point mean values of BP and heart rate after adjusting for sex, baseline values, age, and weight showed no significant difference between groups. Forty-six percent on hydrochlorothiazide/triamterene alone and 24% on diltiazem alone reported one or more adverse events, possibly related to study medication. Patients with diltiazem as the first choice had better BP control than those on hydrochlorothiazide/triamterene alone (81.5% vs. 69.7%). Furthermore, among non-goal achievers at week 12, there was a greater response in the group when hydrochlorothiazide/triamterene was added to diltiazem than when diltiazem was added to hydrochlorothiazide/triamterene. This study suggests that in mild-to-moderate hypertension, diltiazem is better than hydrochlorothiazide/triamterene as first line therapy.
Boulet
A P
AP
Nordic Laboratories, Inc., Laval, Quebec, Canada.
Chockalingam
A
A
Fodor
J G
JG
Laplante
L
L
Houde
M
M
Lenis
J
J
Logan
A G
AG
Robitaille
M N
MN
Ryan
D
D
Spénard
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004110:Diltiazem / Q000009:adverse effects / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000378:metabolism*; D016037:Single-Blind Method; D013997:Time Factors; D014223:Triamterene / Q000009:adverse effects / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D004232:Diuretics; D006852:Hydrochlorothiazide; D004110:Diltiazem; D011188:Potassium; D014223:Triamterene