To compare the efficacy of a calcium-channel blocker (diltiazem) with those of beta-blockers and diuretics in preventing major cardiovascular events in hypertensive patients.
- Antihypertensives Drug
Intervention Desc: This category includes all BP lowering drugs in stroke prevention trials
Approximately half of the eligible patients were randomized to receive diltiazem, and half to receive conventional treatment (beta-blockers, diuretics, or beta-blockers and diuretics in combination). All patients could be prescribed additional medications in a stepwise fashion to reduce diastolic blood pressure to less than 90 mmHg.
Diltiazem patients were initially prescribed 180-360 mg daily. If this did not adequately reduce blood pressure, an ACE inhibitor was added. If this was still insufficient, a diuretic or an alpha-blocker was added. If this failed, any antihypertensive could be added as a fourth step.
In the event that a thiazide diuretic or beta-blocker failed, beta-blocker patients would add a diuretic, and diuretic patients would add a beta-blocker. If this was still inadequate, an ACE inhibitor or an alpha-blocker was added. If blood pressure was still unsatisfactory, any antihypertensive except a calcium-channel blocker could be used as an adjunct.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Stroke, myocardial infarction (MI), cardiovascular death|
|Secondary||Transient ischemic attack (TIA), any death, atrial fibrillation, new diabetes mellitus, congestive heart failure (CHF), any cardiac event|