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Influence of age, sex and blood pressure on the principal endpoints of the Nordic Diltiazem (NORDIL) Study

Kjeldsen, SE; Hedner, T; Syvertsen, JO; Lund-Johansen, P; Hansson, L; Lanke, Jan LU ; Lindholm, LH; de Faire, U; Dahlof, B and Karlberg, BE (2002) In Journal of Hypertension 20(6). p.1231-1237
Abstract
Background The aim of the Nordic Diltiazem (NORDIL) Study was to compare patients with essential hypertension receiving calcium-antagonist-based treatment with diltiazem and similar patients receiving conventional diuretic/beta-blocker-based treatment, with respect to cardiovascular morbidity and mortality. Objective To assess the influence of age, sex, severity of hypertension and heart rate on treatment effects, in a sub-analysis. Methods The NORDIL study was prospective, randomized, open and endpoint-blinded. It enrolled, at health centres in Norway and Sweden, 10881 patients aged 50-74 years who had diastolic blood pressure (DBP) of 100 mmHg or more. Systolic blood pressure (SBP) and DBP were decreased by 20.3/18.7 mmHg in the... (More)
Background The aim of the Nordic Diltiazem (NORDIL) Study was to compare patients with essential hypertension receiving calcium-antagonist-based treatment with diltiazem and similar patients receiving conventional diuretic/beta-blocker-based treatment, with respect to cardiovascular morbidity and mortality. Objective To assess the influence of age, sex, severity of hypertension and heart rate on treatment effects, in a sub-analysis. Methods The NORDIL study was prospective, randomized, open and endpoint-blinded. It enrolled, at health centres in Norway and Sweden, 10881 patients aged 50-74 years who had diastolic blood pressure (DBP) of 100 mmHg or more. Systolic blood pressure (SBP) and DBP were decreased by 20.3/18.7 mmHg in the diltiazem group and by 23.3/18.7 mmHg in the diuretic/beta-blocker group - a significant difference in SBP (P < 0.001). Results The incidence of the primary endpoint - a composite of cardiovascular death, cerebral stroke and myocardial infarction - was similar for the two treatments. Fatal and non-fatal stroke occurred in 159 patients in the diltiazem group and in 196 patients in the conventional treatment group [relative risk MR) 0.80, 95% confidence interval (CO 0.65 to 0.99; P = 0.0401, whereas there was a non-significant inverse tendency with respect to all myocardial infarction. Three Were significantly fewer cerebral strokes ip atiepts receiving diltiazem in the subgroups with baseline SBP > 170 mmHg (n = 5420, RR 0.75,95% CI 0.58 to 0.98; P = 0.032), DBP 105 mmHg (n = 5881, RR 0.74,95% Cl 0.57 to 0.97; P = 0.030) and pulse pressure greater than or equal to 66 mmHg (n = 5461, RR 0.76, 95% Cl 0.58 to 0.99, P = 0.041), and more myocardial infarctions in those with heart rate less than 74 beats/min (n = 5303, RR 1.13, 95% Cl 1.01 to 1.87; P = 0.040). However, the tendencies for fewer strokes and greater incidence of myocardial infarction were present across subgroups when results were analysed for age, sex, severity of hypertension and heart rate, and treatment-subgroup interaction analyses were not statistically significant. Conclusions Compared with a conventional diuretic/beta-blocker-based anti hypertensive regimen, there were additional 25% reductions in stroke in the diltiazem-treated patients with blood pressure or pulse pressure greater than the medians, and an increase in myocardial infarction in those with heart rate less than the median. Such findings may be attributable to chance, but the consistency of, in particular, the stroke findings may also suggest an ability of diltiazem, beyond conventional treatment, to prevent cerebral stroke in hypertensive patients with the greatest cardiovascular risk. (C) 2002 Lippincott Williams Wilkins. (Less)
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Contribution to journal
publication status
published
subject
keywords
myocardial infarction, hypertension, blood pressure, diltiazem, stroke
in
Journal of Hypertension
volume
20
issue
6
pages
1231 - 1237
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:12023696
  • wos:000176027600038
  • scopus:0036591606
ISSN
1473-5598
language
English
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yes
id
dd5e0bb9-8662-455f-86ff-4adc649a70bf (old id 336019)
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http://www.jhypertension.com/pt/re/jhypertension/pdfhandler.00004872-200206000-00038.pdf;jsessionid=Hq0ZpKpWQ1jvVTFPMb0hvnmMZJZMLvQdyJd7G12WWqy1pznKrbLp!1821113646!181195629!8091!-1
date added to LUP
2007-11-02 11:08:06
date last changed
2017-01-08 05:19:45
@article{dd5e0bb9-8662-455f-86ff-4adc649a70bf,
  abstract     = {Background The aim of the Nordic Diltiazem (NORDIL) Study was to compare patients with essential hypertension receiving calcium-antagonist-based treatment with diltiazem and similar patients receiving conventional diuretic/beta-blocker-based treatment, with respect to cardiovascular morbidity and mortality. Objective To assess the influence of age, sex, severity of hypertension and heart rate on treatment effects, in a sub-analysis. Methods The NORDIL study was prospective, randomized, open and endpoint-blinded. It enrolled, at health centres in Norway and Sweden, 10881 patients aged 50-74 years who had diastolic blood pressure (DBP) of 100 mmHg or more. Systolic blood pressure (SBP) and DBP were decreased by 20.3/18.7 mmHg in the diltiazem group and by 23.3/18.7 mmHg in the diuretic/beta-blocker group - a significant difference in SBP (P &lt; 0.001). Results The incidence of the primary endpoint - a composite of cardiovascular death, cerebral stroke and myocardial infarction - was similar for the two treatments. Fatal and non-fatal stroke occurred in 159 patients in the diltiazem group and in 196 patients in the conventional treatment group [relative risk MR) 0.80, 95% confidence interval (CO 0.65 to 0.99; P = 0.0401, whereas there was a non-significant inverse tendency with respect to all myocardial infarction. Three Were significantly fewer cerebral strokes ip atiepts receiving diltiazem in the subgroups with baseline SBP &gt; 170 mmHg (n = 5420, RR 0.75,95% CI 0.58 to 0.98; P = 0.032), DBP 105 mmHg (n = 5881, RR 0.74,95% Cl 0.57 to 0.97; P = 0.030) and pulse pressure greater than or equal to 66 mmHg (n = 5461, RR 0.76, 95% Cl 0.58 to 0.99, P = 0.041), and more myocardial infarctions in those with heart rate less than 74 beats/min (n = 5303, RR 1.13, 95% Cl 1.01 to 1.87; P = 0.040). However, the tendencies for fewer strokes and greater incidence of myocardial infarction were present across subgroups when results were analysed for age, sex, severity of hypertension and heart rate, and treatment-subgroup interaction analyses were not statistically significant. Conclusions Compared with a conventional diuretic/beta-blocker-based anti hypertensive regimen, there were additional 25% reductions in stroke in the diltiazem-treated patients with blood pressure or pulse pressure greater than the medians, and an increase in myocardial infarction in those with heart rate less than the median. Such findings may be attributable to chance, but the consistency of, in particular, the stroke findings may also suggest an ability of diltiazem, beyond conventional treatment, to prevent cerebral stroke in hypertensive patients with the greatest cardiovascular risk. (C) 2002 Lippincott Williams Wilkins.},
  author       = {Kjeldsen, SE and Hedner, T and Syvertsen, JO and Lund-Johansen, P and Hansson, L and Lanke, Jan and Lindholm, LH and de Faire, U and Dahlof, B and Karlberg, BE},
  issn         = {1473-5598},
  keyword      = {myocardial infarction,hypertension,blood pressure,diltiazem,stroke},
  language     = {eng},
  number       = {6},
  pages        = {1231--1237},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Hypertension},
  title        = {Influence of age, sex and blood pressure on the principal endpoints of the Nordic Diltiazem (NORDIL) Study},
  volume       = {20},
  year         = {2002},
}