Skip to main content
SpringerLink
Log in

A comparison of diltiazem and metoprolol in hypertension

  • Originals
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

A double-blind, parallel-group multicentre study has been done to compare the antihypertensive properties, effects on serum lipoproteins and adverse effect profiles of diltiazem and metoprolol given as monotherapy to primary hypertensive patients. 128 patients were included from 10 participating centers.

Following a placebo wash-out period of 5 weeks, patients were randomized either to diltiazem or metoprolol treatment according to a forced titration regimen. Each dose was given for a 4-week period in a stepwise regimen. A total of 119 patients, 59 and 60 in the two groups, completed the study.

Supine and standing BPs were reduced in a similar, dose-dependent fashion by diltiazem and metoprolol. In the former supine BP fell from 161/101 to 151/91 mm Hg at the highest dose level. In the latter patients, supine BP at the highest dose level was reduced from 161/102 to 155/94 mm Hg. Target pressures (DBP ≤ 90 mm Hg and/or DBP reduction of ≥ 10%) were reached in 63% and 48% of the patients, respectively.

HDL-cholesterol was increased in diltiazem-treated patients and decreased in those on metoprolol. Otherwise, serum lipoproteins did not differ significantly between treatments.

The incidence and severity of dose-dependent adverse effects did not differ significantly between treatments, although moderate to distressing side effects were reported more commonly by metoprolol-treated patients. Ankle oedema and breathlessness tended to be more common on diltiazem therapy, while tiredness, increased sweating and sleep disturbances appeared to be experienced more frequently by metoprolol-treated patients.

Thus, when given as monotherapy, the daily dose-ranges for a comperable reduction in BP were 120–360 mg diltiazem and 50–200 mg metoprolol. Within those dose-ranges, the antihypertensive efficacy and the overall incidence of adverse effects did not differ between the treatments. As monotherapies, diltiazem and metoprolol are both suitable for the management of mild to moderate hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Godfraind T, Miller R, Wibo M (1986) Calcium antagonism and calcium entry blockade. Pharmacol Rev 38: 321–416

    Google Scholar 

  2. Kiowski W, Bolli P, Erne P, Hulthén UL, Müller FB, Bühler FR (1988) Hemodynamic and counterregulatory effects of calcium antagonists in hypertension. J Cardiovasc Pharmacol 12 [Suppl 6]: 539–543

    Google Scholar 

  3. Leonetti G, Rupoli L, Gradnik R, Zanchetti A (1987) Effects of a low sodium diet on antihypertensive and natriuretic responses to actue administration of nifedipine. J Hypertension 5 [Suppl 4]: S57-S60

    Google Scholar 

  4. Loutzenhiser RD, Epstein M (1988) Renal hemodynamic effects of calcium antagonists. J Cardiovasc Pharmacol 12 [Suppl 6]: S48-S52

    Google Scholar 

  5. Scriabine A (1987) Comparative pharmacology of 1.4 dihydropyridines and other Ca++ channel ligands. J Cardiovasc Pharmacol 9 [Suppl 1]: S3-S7

    Google Scholar 

  6. Chaffman M, Brogden RN (1985) Diltiazem a review of its pharmacological properties and therapeutic efficacy. Drugs 29: 387–454

    Google Scholar 

  7. Beaufield P, Clissold SP, Brogden RN (1986) Metoprolol. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in hypertension, ischaemic heart disease and related cardiovascular disorders. Drugs 31: 376–429

    Google Scholar 

  8. Wikstrand J, Warnold I, Olsson G, Tuomilehto J, Elmfeldt D, Berglund G (1988) Primary prevention with metoprolol in patients with hypertension: mortality results from the MAPHY study. JAMA 259: 1976–1982

    Google Scholar 

  9. The 1988 Joint National Committée (1988) The 1988 report of the Joint National Committée on detection, evaluation and treatment of high blood pressure. Arch Intern Med 148: 1023–1038

    Google Scholar 

  10. Freestone S, Silas JH, Ramsay LE (1982) Sample size for short-term trials of antihypertensive drugs. Br J Clin Pharmacol 14 (2): 265–268

    Google Scholar 

  11. Altman DG (1980) Statistics and ethics in medical research. III How large a sample? Br Med J 281: 1336–1338

    Google Scholar 

  12. Danielsson B, Ekman R, Fex G, Johansson BG, Kristensson H, Nilsson-Ehle P, Wadstein J (1978) Changes in plasma high density lipoproteins in chronic male alcoholics during and after abuse. Scand J Clin Lab Invest 38: 113–119

    Google Scholar 

  13. Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of LDL cholesterol in plasma without use of the preprative ultracentrifuge. Clin Chem 18: 499–502

    Google Scholar 

  14. Kiowski W, Bühler FR, Fadayomi MO, Erne P, Müller FB, Hulthén UL, Bolli P (1985) Age, race, blood pressure and renin: Predictors for antihypertensive treatment with calicum antagonists. Am J Cardiol 56: 81H-85H

    Google Scholar 

  15. Trimarco B, DeLuca N, Ricciardelli B, Volpe M, Veniero A, Cuocolo A, Cicala M (1984) Diltiazem in the treatment of mild to moderate essential hypertension: comparison with metoprolol in a cross-over double-blind trial. J Clin Pharmacol 24: 218–227

    Google Scholar 

  16. Weir MR, Josselson J, Giard MI, Warren JB, Posner JN, Lam YWF, Zaske DE, Saunders E (1987) Sustained-release diltiazem compared with atenolol monotherapy for mild to moderate systemic hypertension. Am J Cardiol 60: 361–411

    Google Scholar 

  17. Myburgh DP, Gordon NF (1987) Comparison of diltiazem and atenolol in young physically active men with essential hypertension. Am J Cardiol 60: 1092–1095

    Google Scholar 

  18. Pollare T, Lithell H, Ljunghall S, Mörlin C, Präntare H, Hvarfner A (1989) Metabolic effects of diltiazem and atenolol: Results from a randomzied, double-blind study with parallel groups. J Hypertension 7: 551–559

    Google Scholar 

  19. Luurila OJ, Gröhn P, Heikkilä J, Hämäläinen L, Härkönen R, Idänpään-Heikkulä U, Kohvakka A, Rytkönen U, Setälä M, Sundberg S (1987) Exercise capacity and hemodynamics in persons aged 20 to 50 years with systemic hypertension treated with diltiazem and atenolol. Am J Cardiol 60: 832–835

    Google Scholar 

  20. Massie B, MacCarthy EP, Ramanathan KB, Weiss RJ, Anderson M, Eidelson BA, Labreche DG, Tubau JF, Ulep D, Bartels D (1987) Diltiazem and propranolol in mild to moderate essential hypertension as monotherapy or with hydrochlorothiazide. Ann Intern Med 107: 150–157

    Google Scholar 

  21. Szlachcic J, Hirsch AT, Tubau JF, Vollmer C, Henderson S, Massie BM (1987) Diltiazem versus propranolol in essential hypertension: responses of rest and exercise blood pressure and effects on exercise capacity. Am J Cardiol 59: 393–399

    Google Scholar 

  22. Kawanishi DT, Leman RB, Pratt CM, O'Rourke RA (1987) Efficacy and safety of sustained-release diltiazem as replacement therapy for beta blockers and diuretics for stable angina pectoris and coexisting essential hypertension: a multicenter trial. Am J Cardiol 60: 29I-35I

    Google Scholar 

  23. Yamakado T, Oonishi N, Kondo S, Noziri A, Nakano T, Takezawa H (1983) Effects of diltiazem on cardiovascular responses during exercise in systemic hypertension and comparison with propranolol. Am J Cardiol 52: 1023–1027

    Google Scholar 

  24. Pool PE, Seagren SC, Salel AF (1985) Effects of diltiazem on serum lipid, exercise performance and blood pressure: randomized, double-blind placebo-controlled evaluation for systemic hypertension. Am J Cardiol 56: 86H-91H

    Google Scholar 

  25. Schulte K-L, Meyer-Sabellek WA, Haerttenberger A, Thiede H-M, Roecker L, Distler A, Gotzen R (1986) Antihypertensive and metabolic effects of diltiazem and nifedipine. Hypertension 8: 859–865

    Google Scholar 

  26. Schulte K-L, Meyer-Sabellek WA, Röcker L, Gotzen R, Distler A (1987) Effects of diltiazem alone and combined with mefruside on cardiovascular response at rest and during exercise, carbohydrate metabolism and serum lipoproteins in patients with systemic hypertension. Am J Cardiol 60: 826–831

    Google Scholar 

  27. Leren P (1984) Effect of alpha- and beta-blocker therapy on blood lipids: European experience. Am J Med 76 (2A): 67–71

    Google Scholar 

  28. Ames RP (1986) The effects of antihypertensive drugs on serum lipids and lipoproteins. II Non-diuretic drugs. Drugs 32: 335–357

    Google Scholar 

  29. Castelli WP (1984) Epidemiology of coronary heart disease: the Framingham study. Am J Med 76 (2A): 4–12

    Google Scholar 

  30. Weinberger MH (1986) Antihypertensive therapy and lipids. Pradoxical influences on cardiovascular disease risk. Am J Med 80 [Suppl 2A]: 64–70

    Google Scholar 

  31. Hedner T (1986) Calcium channel blockers: Spectrum of side effects and drug interactions. Acta Pharmacol Toxicol 58 [Suppl II]: 119–130

    Google Scholar 

  32. Trost BN, Weidmann P (1987) Effects of calcium antagonists on glucose homeostasis and serum lipids in non-diabetic and diabetic subjects. A review. J Hypertens 5 [Suppl 4]: S81-S104

    Google Scholar 

  33. Andrén L, Höglund P, Dotevall A, Eggertsen R, Svensson A, Olsson S-O, Wadenvik H (1988) Diltiazem in hypertensive patients with type II diabetes mellitus. Am J Cardiol 62: 114G-120G

    Google Scholar 

  34. Szlachcic J, Tubau J, Massie BM (1988) Diltiazem reduces left ventricular mass but does not change diastolic filling in mild hypertension. J Am Coll Cardiol 11: 82A

  35. Weiss RJ, Bent R (1987) Diltiazem-induced left ventricular mass regression in hypertensive patients. J Clin Hypertension 3: 135–143

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacology, Sahlgrenska University Hospital, S-413 45, Gothenburg, Sweden

    T. Hedner, T. Thulin, S. Gustafsson MD & S.-O. Olsson

Authors
  1. T. Hedner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Thulin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Gustafsson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S.-O. Olsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

For the Swedish Diltiazem-Metoprolol Multicentre Study Group

The Swedish Diltiazem-Metoprolol Multicentre Study Group: Thomas Hedner MD PhD, Jan Hedner MD PhD, Bengt Persson MD PhD (Gothenburg); Thomas Thulin MD PhD, Gunnar Persson MD PhD (Lund); Torbjörn Lundström MD (Skövde); Nels Henningsen MD PhD (Malmö); Erik Trell MD PhD, Sven Gustafsson MD (Sunne); Mats Danielson MD PhD (Stockholm); Peter Engfeldt MD PhD, Hans Wahrenberg MD PhD (Huddinge); Bo Hedbäck MD PhD (Oskarshamn); Anders Nilsson MD, Per Katzman MD PhD (Helsingborg); Lennart Andrén MD PhD, Karin Rennblad-Börner MD, Trausti Valdimarsson MD, Inger Wallin MD (Gothenburg); Peter Nilsson-Ehle MD PhD, Ulf Thilén MD, Göran Berglund MD PhD (Lund-Malmö); Carl Dahlöf MD PhD (Gothenburg)

Monitors: Sven-Olle Olsson PhD, Jan Johansson, Eje Berglund, Bo Dahlström (Malmö)

Statisticians: Jerker Ringström BSc, Liz Jergle BSc (Malmö)

Secretaries: Cristina Mardell, Ann-Christine Svensson, Majliz Olsson (Malmö)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hedner, T., Thulin, T., Gustafsson, S. et al. A comparison of diltiazem and metoprolol in hypertension. Eur J Clin Pharmacol 39, 427–433 (1990). https://doi.org/10.1007/BF00280931

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00280931

Key words

Search

Navigation