Diltiazem vs amlodipine
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Comparative Analysis of Diltiazem vs Amlodipine
Introduction to Calcium Channel Blockers
Calcium channel blockers, such as diltiazem and amlodipine, are commonly prescribed for managing hypertension and angina. These medications work by inhibiting calcium ions from entering cardiac and smooth muscle cells, leading to vasodilation and reduced blood pressure. This article synthesizes research comparing the efficacy, safety, and patient compliance of diltiazem and amlodipine.
Efficacy in Blood Pressure Control
Blood Pressure Reduction
Both diltiazem and amlodipine effectively reduce blood pressure in patients with hypertension. A study comparing these drugs found that amlodipine significantly reduced systolic and diastolic blood pressures more than diltiazem over a 10-week period. Another study confirmed that both medications provide stable, persistent blood pressure reduction over 24 hours, with amlodipine showing a larger decrease in systolic blood pressure.
Impact of Missed Doses
Amlodipine, with its longer elimination half-life, maintains blood pressure control better during short periods of noncompliance compared to diltiazem. In a study where therapy was interrupted for two days, amlodipine's blood pressure-lowering effects persisted, whereas diltiazem's effects diminished significantly.
Efficacy in Angina Management
Antianginal Efficacy
Both amlodipine and diltiazem are effective in reducing the frequency of angina attacks and nitroglycerin consumption. Studies have shown that both drugs improve exercise test parameters, such as total exercise time and time to onset of angina, although the differences between the two were not statistically significant . However, amlodipine has the advantage of once-daily dosing, which may enhance patient compliance .
Total Ischemic Burden
The CAPE II trial highlighted that amlodipine significantly reduces the total ischemic burden, including both symptomatic and asymptomatic ischemic events, over 24 hours. This suggests that amlodipine may offer better management of the circadian pattern of transient myocardial ischemia compared to diltiazem.
Safety and Tolerability
Adverse Events
Both medications are generally well-tolerated, but diltiazem is associated with a higher incidence of adverse events. In a study of patients with angina resistant to atenolol, 36% of patients on diltiazem reported adverse events compared to 30% on amlodipine, with diltiazem patients experiencing nearly twice as many adverse events. Another study found that the incidence of edema was significantly lower in patients receiving diltiazem compared to amlodipine.
Long-Term Safety
In terms of long-term safety, both drugs caused significant reductions in left ventricular mass without activating the sympathetic nervous system, which is a positive outcome for patients with hypertension and high-normal left ventricular mass.
Conclusion
Both diltiazem and amlodipine are effective calcium channel blockers for managing hypertension and angina. Amlodipine offers advantages in terms of better blood pressure control during missed doses and once-daily dosing, which may improve patient compliance. However, diltiazem may be better tolerated with fewer incidences of edema. The choice between these medications should be tailored to individual patient needs, considering factors such as dosing convenience, potential side effects, and specific clinical scenarios.
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