Thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first-step antihypertensive therapy.

1 Calcium antagonists with long us short elimination half-life may show marked differences in their antihypertensive effect during short interruptions of therapy by missed doses. 2 In the present study we evaluated the blood pressure lowering effect of amlodipine us diltiazem both on active maintenance treatment and after active treatment was interrupted for 2 days by placebo using a double-blind randomized design. After a single blind placebo run-in period, hypertensive patients were randomized to amlodipine 5 mg once daily or diltiazem 90 mg twice daily. After 4-6 weeks, doses were increased to 10mg once daily or 180 mg twice daily, if necessary for control of diastolic blood pressure. During week 9 or 10 on active treatment blisterpacks contained 2 days of placebo. Twenty-four hour blood pressure monitoring was performed at the end of runin period and during week 9 and 10 on active us interrupted therapy. 3 Active therapy by amlodipine (n=20) lowered day systolic blood pressure by 17 f 2 mmHg and diastolic blood pressure by 12+2 mmHg and did not change heart rate. In second day of interrupted therapy most of these responses were still present. Diltiazem (n = 14) lowered day systolic blood pressure by 13 & 2 mmHg, diastolic blood pressure by 11 & 2 mmHg and heart rate by 10 1 2 beats min-'. Most of these responses had disappeared during the second day of interrupted therapy. 4 We conclude that amlodipine and diltiazem are fairly similar in lowering blood pressure from an efficacy point of view. However, during short periods of noncompliance blood pressure control will persist markedly better with the agent with a long us the one with a short elimination half-life.

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