Comparison of diltiazem, nitrendipine, and their combination for systemic hypertension and stable angina pectoris.

The relative efficacies of 240 mg/day diltiazem and 20 mg/day nitrendipine were compared in a placebo-controlled, randomized, crossover study of 48 patients who had both moderate systemic hypertension and stable angina pectoris. Hemodynamic indices were measured by impedance cardiography and echocardiography and bicycle ergometry was performed. Compared with placebo, both diltiazem and nitrendipine decreased systolic (p less than 0.05 for both) and diastolic (p less than 0.05 for both) blood pressure, the total peripheral vascular resistance (p less than 0.01 for both), the frequency of anginal attacks (p less than 0.001 for both) and nitroglycerin usage (p less than 0.01 for both), and increased exercise duration (p less than 0.01 and p less than 0.05), exercise time to angina (p less than 0.01 and p less than 0.05) and time to the onset of ST-segment deviation (p less than 0.01 and p less than 0.05). There were no significant differences in the antihypertensive and antianginal effects of the two drugs. Resting heart rate was increased from placebo baseline with nitrendipine (p less than 0.01) during the first week of the treatment, and the reduction of the rate-pressure product and the decrease of the left ventricular mass were greater using diltiazem (p less than 0.05). Sixteen patients had insufficient responses to monotherapy and continued in the study for additional treatment with the combination 120 mg/day diltiazem and 20 mg/day nitrendipine. The normalization of diastolic blood pressure was achieved and more pronounced rate-pressure product reduction was found. No additional side effects were mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)