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Verapamil vs diltiazem for hypertension
We have seen that a short time course of diltiazem (10-15 mg/d) resulted in a greater reduction the frequency of diastolic blood flow than did oral nifedipine (8 mg/d). However, the mean reduction in diastolic blood flow was not different between the 2 treatment groups and was not consistent with the increase in diastolic blood flow observed with the use of antihypertensive agent. An earlier, prospective, open-label, single-arm study by Dorn and colleagues reported greater reductions in mean diastolic blood pressure with oral nifedipine (10 mg/d) than with diltiazem (8 (14). However, because the reduction in diastolic blood pressure was not consistent, these investigators had insufficient statistical power to detect a difference in diastolic blood pressure. The Dorn investigators also noted that the diastolic blood pressures were lower with Adderal 120 $360.00 $3.00 $324.00 nifedipine than diltiazem.
The use of a daily high dose oral nifedipine (75 mg) is recommended in patients with mild hypertension and in patients with moderate to severe hypertension. As mentioned above, the dose of oral nifedipine used in our study was increased from 4 mg to 8 mg/d when the patient already treated with an oral nifedipine dose of 4 mg per day. This may have influenced the results of our study. It is conceivable that a higher dose of oral nifedipine might have resulted in greater reduction of diastolic blood flow, but we did not have such data.
In patients with moderate-to-severe hypertension, doses of up to 75 mg oral nifedipine per day are recommended because the risk of hypertension with this high dose is low and it usually well tolerated. However, in our study, no difference blood pressure reduction was found between doses of nifedipine 4 mg and 8 mg/d. The lack of a significant difference between 4 mg and 8 mg/d may be related to the lack of response seen in the dose-dependent analysis.
The use of dalteparin as an antihypertensive agent has been associated with an increase in venous thromboembolism. We had a small number of patients with severe coronary artery disease in our study. Thus, the increase in venous thromboembolism is unlikely to have contributed our Modafinil 100mg buy online finding that dalteparin caused a greater reduction in blood pressure our study than did oral nifedipine with the addition of diltiazem.
Our study has some limitations. It was a cross-over trial of 2 groups; the diltiazem group that received placebo and the oral nifedipine group that received diltiazem. The study was not a randomized controlled trial. Thus, the differences between groups may be attributable to factors other than diltiazem use. Thus, the effect of diltiazem on blood pressure was not confirmed by a randomized controlled trial.
There were more patients in the diltiazem group than oral nifedipine with a mean age of 54 years (95% confidence interval [CI], 45 to 61 years). The mean blood pressure reduction for the diltiazem group compared with oral nifedipine was 4 mm Hg greater for diastolic blood pressure and about 3 mm Hg greater for systolic blood pressure. The use of a high dose diltiazem may have given an inflated response for the venous thromboembolism effect. Because diltiazem group did not have a higher rate of venous thromboembolism, we could not confirm that the diltiazem use was a reason for the greater blood pressure reduction than for the oral nifedipine group. In addition, the venous thromboembolism rate in diltiazem group was not higher than in the oral nifedipine group. A higher percentage of patients in the diltiazem group would increase our confidence that results were not due to a lower incidence of venous thromboembolism in the diltiazem group than oral nifedipine group. However, Phentermine 37.5 buy uk the incidence of venous thromboembolism in the diltiazem group was 0.5% (3 of 2,315 patients) for diastolic blood pressure, 0.4% (2 of 2,315 patients) for systolic blood pressure, and 2% (3 of 2,315 patients) for the composite of diastolic and systolic blood pressure.
The authors' responsibilities were as follows—KLH and GMS: conceived of the study, designed and performed primary analyses;
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