Amlodipine and diltiazem
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Some studies suggest amlodipine is better tolerated, more cost-effective, and maintains blood pressure control better during noncompliance, while other studies suggest diltiazem is more effective but associated with more serious adverse events.
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Comparative Analysis of Amlodipine and Diltiazem
Antianginal Efficacy and Tolerability
Amlodipine and diltiazem are both effective in reducing the frequency of angina attacks and the consumption of glyceryl trinitrate in patients with angina resistant to atenolol alone. Both drugs significantly reduce the overall frequency of ambulatory myocardial ischemia, although these changes do not reach statistical significance. Exercise test parameters, such as total exercise time and time to angina, tend to improve with both treatments but without significant differences between the two drugs. However, diltiazem is associated with more frequent and serious adverse events compared to amlodipine.
Blood Pressure Control and Compliance
Amlodipine and diltiazem are both effective in lowering blood pressure in hypertensive patients. Amlodipine, with its long elimination half-life, maintains blood pressure control better during short periods of noncompliance compared to diltiazem, which has a shorter half-life. This makes amlodipine a more reliable option for patients who may miss doses occasionally.
Treatment of Symptomatic Myocardial Ischemia
In patients with symptomatic myocardial ischemia, amlodipine and diltiazem both reduce blood pressure and the rate-pressure product. Amlodipine shows a greater reduction in blood pressure and angina attacks compared to diltiazem. Additionally, amlodipine improves the high-density lipoprotein cholesterol/total cholesterol ratio and decreases triglycerides more effectively than diltiazem. Both drugs have a comparable incidence and severity of side effects.
Stable Exertional Angina Pectoris
In patients with stable exertional angina pectoris, both amlodipine and diltiazem improve exercise tolerance and reduce the frequency of angina attacks and nitroglycerin tablet consumption. The incidence and severity of side effects are similar for both drugs, but amlodipine has the advantage of once-daily dosing, which may improve patient compliance .
Reduction of Total Ischemic Burden
The CAPE II trial aims to compare the efficacy of amlodipine and diltiazem in reducing the total ischemic burden in patients with chronic stable angina. Amlodipine, with its long half-life, may maintain better clinical efficacy during irregular dosing periods compared to diltiazem, which has a short half-life but is formulated for extended release.
Effects on Left Ventricular Mass and Plasma Catecholamines
Both amlodipine and diltiazem reduce left ventricular mass and plasma catecholamines in patients with mild to moderate hypertension. Amlodipine causes a larger decrease in systolic blood pressure and left ventricular mass compared to diltiazem. Both drugs provide stable blood pressure control over 24 hours without activating the sympathetic nervous system.
Hypertension Management
In the treatment of mild to moderate hypertension, amlodipine is more effective than diltiazem in reducing both systolic and diastolic blood pressures. Amlodipine achieves target blood pressures more consistently and is well tolerated, making it a preferable option for long-term hypertension management.
Conclusion
Both amlodipine and diltiazem are effective calcium channel blockers for the treatment of angina and hypertension. Amlodipine offers advantages in terms of better blood pressure control during noncompliance, greater reduction in blood pressure and left ventricular mass, and once-daily dosing, which may enhance patient adherence. Diltiazem, while effective, is associated with more frequent adverse events and requires more frequent dosing. The choice between these two drugs should consider individual patient needs, potential side effects, and dosing convenience.
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