In a randomized, double-blind, placebo-controlled crossover trial, diltiazem and nifedipine were compared in 10 patients with stable angina pectoris and mild to moderate hypertension (supine diastolic blood pressure ≥90 mm Hg). Patients received placebo for 2 weeks, then increasing doses of diltiazem (90 to 360 mg/day) or nifedipine (30 to 120 mg/day) in 3 daily divided doses over 2 weeks, followed by 1 week of therapy at the maximal dose, a 1-week placebo "washout," then crossover to the other drug. Heart rate and blood pressure at rest and during exercise, anginal frequency, nitroglycerin consumption and treadmill exercise tolerance were assessed. Compared with placebo, anginal frequency and nitroglycerin consumption were reduced with both diltiazem and nifedipine (p < 0.01) and exercise tolerance was increased with both drugs (p < 0.01). Standing blood pressure at rest was reduced by diltiazem and nifedipine ( 146.6 ± 11.4 97.7 ± 5.3 mm Hg at placebo, baseline reduced to 129.6 ± 15.2 79.5 ± 13.7 mm Hg with diltiazem, and to 122.2 ± 9.9 82.0 ± 7.1 with nifedipine, p < 0.01 for both). Compared with placebo, diltiazem and nifedipine also reduced exercise diastolic blood pressure (p < 0.01), but not systolic blood pressure. Diltiazem lowered the heart rate at rest from 88.5 ± 14.4 beats/min at placebo baseline to 79.7 ± 17.9 beats/min (p < 0.01); the heart rate with diltiazem was 11 beats/min lower than that with nifedipine (p < 0.05). Both diltiazem and nifedipine had similar effects on the heart rate-blood pressure product at rest and during exercise. Both drugs were well tolerated. Thus, diltiazem and nifedipine appear equally effective and safe in patients with both hypertension and angina pectoris by relieving angina, improving exercise tolerance and reducing elevated blood pressure.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine