Evidence map›Paper›PMID 9486993›Full record

Trial reportThe New England journal of medicine1998

The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension.

R O Estacio, B W Jeffers, W R Hiatt, S L Biggerstaff, N Gifford, R W Schrier

Open access · bronzeAbstract readClinical TrialComparative StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 1998. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 230 papers, 38 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
230citing papers in PubMed, 38 pooled it
83.9field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

230 citing papers in PubMed, 38 syntheses or guidelines pooled it, 1,177 citations in OpenAlex.

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  7. Blood pressure control for diabetic retinopathy.The Cochrane database of systematic reviews · 2023
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  9. Calcium channel blockers versus other classes of drugs for hypertension.The Cochrane database of systematic reviews · 2022
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  10. Guideline
  11. Calcium channel blockers versus other classes of drugs for hypertension.The Cochrane database of systematic reviews · 2021
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  13. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
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170 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 2 countries.

R O EstacioColorado Prevention Center, Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver 80262, USA.
B W Jeffers
W R Hiatt
S L Biggerstaff
N Gifford
R W Schrier
Denver Health Medical Center · USUniversity of Colorado Health · US

Funding

APPROPRIATE BLOOD PRESSURE CONTROL IN DIABETESR01DK050298 · NIDDK · UNIVERSITY OF COLORADO DENVER · PI SCHRIER, ROBERT W · 1996 to 1998
–
NIDDK NIH HHS DK50298-02
6 · The paper itself

Abstract

backgroundIt has recently been reported that the use of calcium-channel blockers for hypertension may be associated with an increased risk of cardiovascular complications. Because this issue remains controversial, we studied the incidence of such complications in patients with non-insulin-dependent diabetes mellitus and hypertension who were randomly assigned to treatment with either the calcium-channel blocker nisoldipine or the angiotensin-converting-enzyme inhibitor enalapril as part of a larger study.

methodsThe Appropriate Blood Pressure Control in Diabetes (ABCD) Trial is a prospective, randomized, blinded trial comparing the effects of moderate control of blood pressure (target diastolic pressure, 80 to 89 mm Hg) with those of intensive control of blood pressure (diastolic pressure, 75 mm Hg) on the incidence and progression of complications of diabetes. The study also compared nisoldipine with enalapril as a first-line antihypertensive agent in terms of the prevention and progression of complications of diabetes. In the current study, we analyzed data on a secondary end point (the incidence of myocardial infarction) in the subgroup of patients in the ABCD Trial who had hypertension.

resultsAnalysis of the 470 patients in the trial who had hypertension (base-line diastolic blood pressure, > or = 90 mm Hg) showed similar control of blood pressure, blood glucose and lipid concentrations, and smoking behavior in the nisoldipine group (237 patients) and the enalapril group (233 patients) throughout five years of follow-up. Using a multiple logistic-regression model with adjustment for cardiac risk factors, we found that nisoldipine was associated with a higher incidence of fatal and nonfatal myocardial infarctions (a total of 24) than enalapril (total, 4) (risk ratio, 9.5; 95 percent confidence interval, 2.7 to 33.8).

conclusionsIn this population of patients with diabetes and hypertension, we found a significantly higher incidence of fatal and nonfatal myocardial infarction among those assigned to therapy with the calcium-channel blocker nisoldipine than among those assigned to receive enalapril. Since our findings are based on a secondary end point, they will require confirmation.

Indexed as

AdultAgedAngiotensin-Converting Enzyme InhibitorsCalcium Channel BlockersCardiovascular DiseasesDiabetes Mellitus, Type 2Double-Blind MethodEnalaprilFemaleHumansHypertensionLogistic ModelsMaleMiddle AgedMyocardial InfarctionNisoldipineAngiotensin-Converting Enzyme InhibitorsCalcium Channel BlockersEnalaprilNisoldipine

Identifiers

PMID9486993
OpenAlexW2312999996

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.