• In the SYST-EUR study nitrendipine showed a reduction in the risk of stroke
inisolated systolic hypertension when compared to diuretics (Lancet 1997; 350: 757-64).
• In the Swedish Trial in Old Patients with Hypertension-2 (STOP-2) study, there was some evidence that the risks of myocardial infarction and of heart failure were greater with calcium antagonist based therapy than with ACE-inhibitor based therapy, but there were no clear differences between either of these regimens and a third based on diuretics and beta-blockers (Lancet 1999; 354: 1751-6). In this study 34-39% of patients withdrew from the three treatment regimens.
• The International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment
(INSIGHT) trial compared long-acting nifedipine with a diuretic (hydrochlorothiazide and amiloride combination) and found that the calcium channel antagonist was as effective as diuretics in preventing overall cardiovascular or cerebrovascular complications (Lancet 2000; 356: 366-72). There was a marginally significant excess of heart failure with nifedipine-based treatment. Fatal myocardial infarctions were more common in the nifedipine group. There was an 8% excess withdrawal of drug in the nifedipine group because of peripheral oedema whereas serious adverse events were more frequent in the diuretic group.
• In the Nordic Diltiazem Study (NORDIL) from Sweden diltiazem was compared with diuretics,
beta-blockers or both (Lancet 2000; 356: 359-65). This study found that diltiazem was as effective as treatment based on diuretics, beta-blockers or both in preventing the primary end point of all stroke, myocardial infarction and other cardiovascular deaths. There was a marginally significant lower risk of stroke in the diltiazem group despite a lesser reduction in blood pressure. In this study, 23% of the patients withdrew from the diltiazem-based group and 7% withdrew from diuretic-based and beta-blocker based therapy.