COMPARISON OF THE EFFICACY AND SAFETY OF DILTIAZEM AND CAPTOPRIL IN MILD-TO-MODERATE ESSENTIAL-HYPERTENSION

This 12-week, double-blind multicenter study was performed to compare the efficacy and safety of the calcium antagonist diltiazem and the AC E inhibitor captopril in patients with mild to moderate stable essenti al hypertension. Following a 2-week placebo-washout phase, 58 outpatie nts with diastolic blood pressure greater-than-or-equal-to 95 mmHg and < 115 mmHg were randomly assigned to a therapy with either diltiazem 180 mg once daily (n = 27) or captopril 50 mg once daily (n = 31). The average age was 57 years in both groups. If diastolic blood pressure was still higher than 90 mmHg after 2 weeks, the dose was to be titrat ed to diltiazem 270 mg daily or captopril 75 mg daily, respectively. 2 2 patients of the diltiazem and 30 patients of the captopril group com pleted the study. Efficacy was evaluated using 24-h ambulatory blood p ressure monitoring (ABPM) measurements. The mean 24-h baseline value o f diastolic blood pressure was 93 mmHg in both treatment groups, and w as reduced by a mean of 6.8 mmHg with both forms of therapy. While for the average reduction of the 24-h blood pressure no differences betwe en the treatment groups were found, the mean baseline value of day-tim e diastolic blood pressure of 97 mmHg in both groups was reduced by 7. 7 mmHg in the diltiazem and by 4.0 mmHg in the captopril group, and th e mean night-time diastolic blood pressure of 85 mmHg in both groups w as reduced by 5.0 mmHg in the diltiazem and by 8.1 mmHg in the captopr il group. A total of four patients in the diltiazem group reported sev en adverse events, all resulting in withdrawal from the study. No adve rse events were reported in the captopril group. In conclusion, diltia zem and captopril showed comparable reductions in mean 24-h blood pres sure, but relatively marked differences for the day- and night-time va lues. Possibly, that may be an advantage of diltiazem. According to th e results of this study, the tolerability of captopril seems to be som ewhat better than that of diltiazem.