Trial reportLancet (London, England)2000
Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study.
Trial report in Lancet (London, England), 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 190 papers, 31 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
190 citing papers in PubMed, 31 syntheses or guidelines pooled it, 901 citations in OpenAlex.
- Agreement Between Mega-Trials and Smaller Trials: A Systematic Review and Meta-Research Analysis.JAMA network open · 2024Pooled it
- Calcium channel blockers versus other classes of drugs for hypertension.The Cochrane database of systematic reviews · 2022Pooled it
- Calcium channel blockers versus other classes of drugs for hypertension.The Cochrane database of systematic reviews · 2021Pooled it
- Blood pressure-lowering treatment for the prevention of cardiovascular events in patients with atrial fibrillation: An individual participant data meta-analysis.PLoS medicine · 2021Pooled it
- Pharmacotherapy for hypertension in adults 60 years or older.The Cochrane database of systematic reviews · 2019Pooled it
- First-line drugs for hypertension.The Cochrane database of systematic reviews · 2018Pooled it
- Pharmacotherapy for hypertension in adults aged 18 to 59 years.The Cochrane database of systematic reviews · 2017Pooled it
- Beta-blockers for hypertension.The Cochrane database of systematic reviews · 2017Pooled it
- 7th Brazilian Guideline of Arterial Hypertension: Chapter 7 - Pharmacological TreatmentArquivos brasileiros de cardiologia · 2016Guideline
- Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals.The Cochrane database of systematic reviews · 2016Pooled it
- Guideline
- Calcium channel blocker compared with angiotensin receptor blocker for patients with hypertension: a meta-analysis of randomized controlled trials.Journal of clinical hypertension (Greenwich, Conn.) · 2014Pooled it
- Beta-blockers for preventing stroke recurrence.The Cochrane database of systematic reviews · 2014Pooled it
- Pharmacological interventions for hypertension in children.The Cochrane database of systematic reviews · 2014Pooled it
- Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses.Current hypertension reports · 2013Pooled it
- Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2013Pooled it
- Pooled it
- Antihypertensive agents for preventing diabetic kidney disease.The Cochrane database of systematic reviews · 2012Pooled it
- Comparative effectiveness of antihypertensive medication for primary prevention of cardiovascular disease: systematic review and multiple treatments meta-analysis.BMC medicine · 2012Pooled it
- Diabetes: treating hypertension.BMJ clinical evidence · 2012Pooled it
130 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors at 8 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCalcium antagonists are a first-line treatment for hypertension. The effectiveness of diltiazem, a non-dihydropyridine calcium antagonist, in reducing cardiovascular morbidity or mortality is unclear. We compared the effects of diltiazem with that of diuretics, beta-blockers, or both on cardiovascular morbidity and mortality in hypertensive patients.
methodsIn a prospective, randomised, open, blinded endpoint study, we enrolled 10,881 patients, aged 50-74 years, at health centres in Norway and Sweden, who had diastolic blood pressure of 100 mm Hg or more. We randomly assigned patients diltiazem, or diuretics, beta-blockers, or both. The combined primary endpoint was fatal and non-fatal stroke, myocardial infarction, and other cardiovascular death. Analysis was done by intention to treat.
findingsSystolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and beta-blocker groups (reduction 20.3/18.7 vs 23.3/18.7 mm Hg; difference in systolic reduction p<0.001). A primary endpoint occurred in 403 patients in the diltiazem group and in 400 in the diuretic and beta-blocker group (16.6 vs 16.2 events per 1000 patient-years; relative risk 1.00 [95% CI 0.87-1.15], p=0.97). Fatal and non-fatal stroke occurred in 159 patients in the diltiazem group and in 196 in the diuretic and beta-blocker group (6.4 vs 7.9 events per 1000 patient-years; 0.80 [0.65-0.99], p=0.04) and fatal and non-fatal myocardial infarction in 183 and 157 patients (7.4 vs 6.3 events per 1000 patient-years; 1.16 [0.94-1.44], p=0.17).
interpretationDiltiazem was as effective as treatment based on diuretics, beta-blockers, or both in preventing the combined primary endpoint of all stroke, myocardial infarction, and other cardiovascular death.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.