Summary

Background The efficacy of antihypertensive drugs newer than diuretics and -blockers has not been established. We compared the effects of the calcium-channel blocker nifedipine once daily with the diuretic combination co-amilozide on cardiovascular mortality and morbidity in high-risk patients with hypertension. Methods We did a prospective, randomised, double-blind trial in Europe and Israel in 6321 patients aged 55–80 years with hypertension (blood pressure 150/95 mm Hg, or 160 mm Hg systolic). Patients had at least one additional cardiovascular risk factor. We randomly assigned patients nifedipine 30 mg in a long-acting gastrointestinal-transport-system (GITS) formulation (n=3157), or co-amilozide (hydrochlorothiazide 25 g plus amiloride 2·5 mg; n=3164). Dose titration was by dose doubling, and addition of atenolo