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 ambul atory 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 pre ssure (SBP) >160 mm Hg and diastolic blood pressure (DBP) >90 mm Hg bu t <110 mm Hg, After a 4-week placebo washout period, patients were tre ated with SR diltiazem 300 mg once daily for 6 months. At the end of t he placebo period and after 1, 3, and 6 months of treatment, BP was me asured in both the sitting and standing positions, an electrocardiogra m and an M-mode echocardiogram were performed, and ambulatory BP was m onitored noninvasively. SR diltiazem significantly lowered both sittin g 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 statist ically but not clinically significant decrease in HR was observed. Ech ocardiographic measurements demonstrated a significant reduction in le ft ventricular mass index (LVMI) (18%) and in left ventricular wall th ickness (posterior mall, 19%; interventricular septum, 17%) versus pla cebo, with no change in fractional shortening or diastolic filling tim e. The treatment was well tolerated, and no serious side effects mere reported. The results of this study suggest that once-daily administra tion of SR diltiazem 300 mg was well tolerated and effective in reduci ng both sitting and standing BP as well as ambulatory BP and LVMI in e lderly patients with hypertension, without causing deterioration in ca rdiac function.