Treatment of mild-to-moderate hypertension: comparison between a calcium-channel blocker and a potassium-sparing diuretic.

Abstract

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.

• Authors: A P Boulet, A Chockalingam, J G Fodor, L Laplante, M Houde, J Lenis, A G Logan, M N Robitaille, D Ryan, J Spénard
• Journal: Journal of cardiovascular pharmacology (J Cardiovasc Pharmacol) Vol. 18 Suppl 9 Pg. S45-50 ( 1991) ISSN: 0160-2446 [Print] United States
• PMID: 1725543 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Calcium Channel Blockers
• Diuretics
• Hydrochlorothiazide
• Diltiazem
• Potassium
• Triamterene

Topics

• Adolescent
• Adult
• Aged
• Calcium Channel Blockers (therapeutic use)
• Diltiazem (adverse effects, therapeutic use)
• Diuretics (therapeutic use)
• Double-Blind Method
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Humans
• Hydrochlorothiazide (adverse effects, therapeutic use)
• Hypertension (drug therapy)
• Male
• Middle Aged
• Potassium (metabolism)
• Single-Blind Method
• Time Factors
• Triamterene (adverse effects, therapeutic use)