Effect of sustained-release diltiazem on ambulatory blood pressure and left ventricular mass in elderly patients with hypertension

The effect of sustained-release (SR) diltiazem 300 mg on 24-hour ambulatory blood pressure (BP), heart rate (HR), and left ventricular mass was evaluated in 35 elderly patients aged 75 to 84 years with mild-to-moderate essential hypertension, defined as sitting systolic blood pressure (SBP) >160 mm Hg and diastolic blood pressure (DBP) >90 mm Hg but <110 mm Hg, After a 4-week placebo washout period, patients were treated with SR diltiazem 300 mg once daily for 6 months. At the end of the placebo period and after 1, 3, and 6 months of treatment, BP was measured in both the sitting and standing positions, an electrocardiogram and an M-mode echocardiogram were performed, and ambulatory BP was monitored noninvasively. SR diltiazem significantly lowered both sitting and standing SEP and DBP at trough levels. Ambulatory BP monitoring confirmed consistent antihypertensive activity throughout the 24-hour dosing interval, without affecting the circadian BP profile. A statistically but not clinically significant decrease in HR was observed. Echocardiographic measurements demonstrated a significant reduction in left ventricular mass index (LVMI) (18%) and in left ventricular wall thickness (posterior mall, 19%; interventricular septum, 17%) versus placebo, with no change in fractional shortening or diastolic filling time. The treatment was well tolerated, and no serious side effects mere reported. The results of this study suggest that once-daily administration of SR diltiazem 300 mg was well tolerated and effective in reducing both sitting and standing BP as well as ambulatory BP and LVMI in elderly patients with hypertension, without causing deterioration in cardiac function.