title: Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease.
abstract: OBJECTIVE
  Antihypertensive therapy with thiazides decreases coronary events in elderly patients. However, the influence of diuretics on myocardial ischemia has not been fully investigated. The aim of this study was to compare the effect of chlorthalidone and diltiazem on myocardial ischemia.
  
  
  METHODS
  Following a randomized, double-blind, crossover protocol, we studied 15 elderly hypertensive patients aged 73.6+/-4.6 years with myocardial ischemia. All patients had angiographically documented coronary artery disease. We measured patients using 48- hour ambulatory electrocardiogram monitoring and exercise testing. After a 2-week period using placebo, patients received chlorthalidone or diltiazem for 4 weeks.
  
  
  RESULTS
  Both treatments lowered systolic and diastolic blood pressures. The number of ischemic episodes on ambulatory electrocardiogram recordings was reduced with the use of chlorthalidone (2.5+/-3.8) and diltiazem (3.2+/-4.2) when compared with placebo (7.9+/-8.8; p<0.05). The total duration of ischemic episodes was reduced in both treatments when compared with placebo (chlorthalidone: 19.2+/-31.9min; diltiazem: 19.3+/-29.6min; placebo: 46.1+/-55.3min; p<0.05).
  
  
  CONCLUSIONS
  In elderly hypertensive patients with coronary artery disease, chlorthalidone reduced myocardial ischemia similarly to diltiazem. This result is consistent with epidemiological studies and suggests that reduction of arterial blood pressure with thiazide therapy plays an important role in decreasing myocardial ischemia.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, 05403-000, Brazil.
authors.forename: J B
authors.initials: JB
authors.lastname: Serro-Azul
authors.forename: R S
authors.initials: RS
authors.lastname: de Paula
authors.forename: C
authors.initials: C
authors.lastname: Gruppi
authors.forename: L
authors.initials: L
authors.lastname: Pinto
authors.forename: H
authors.initials: H
authors.lastname: Pierri
authors.forename: A
authors.initials: A
authors.lastname: Nussbacher
authors.forename: O
authors.initials: O
authors.lastname: Gebara
authors.forename: P
authors.initials: P
authors.lastname: Moffa
authors.forename: A C
authors.initials: AC
authors.lastname: Pereira-Barreto
authors.forename: M
authors.initials: M
authors.lastname: Wajngarten
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002752:Chlorthalidone / Q000494:pharmacology / Q000627:therapeutic use*; D003327:Coronary Disease / Q000150:complications; D004110:Diltiazem / Q000494:pharmacology / Q000627:therapeutic use*; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics; D004110:Diltiazem; D002752:Chlorthalidone