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Demographic factors and the antihypertensive effect of diltiazem
Insights
Older adults do not show increased sensitivity to diltiazem, a calcium channel blocker. Blood pressure reduction with this medication depends on baseline blood pressure, not age.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Calcium antagonists are often considered more effective in older hypertensive patients.
- However, the dose-response relationship and actual sensitivity in elderly individuals remain unclear.
Purpose of the Study:
- To investigate the influence of pretreatment blood pressure (BP), age, and weight on BP and heart rate (HR) response to diltiazem.
- To determine if elderly patients exhibit increased sensitivity to diltiazem compared to younger patients.
Main Methods:
- 231 hypertensive patients (aged 24-82 years) received a fixed dose of diltiazem (120 mg b.i.d.) for 14 days.
- Evaluated BP and HR changes in relation to pretreatment BP, age, and weight.
Main Results:
- Diltiazem significantly reduced systolic BP (SBP) and diastolic BP (DBP).
- BP reduction was strongly correlated with pretreatment BP levels (p < 0.0001).
- No significant difference in BP reduction was observed between elderly (≥60 years) and younger patients.
Conclusions:
- Diltiazem's BP-lowering effect is primarily determined by baseline BP, not patient age.
- The notion of enhanced calcium antagonist efficacy in the elderly is not supported by this study's findings for diltiazem.
- This challenges the use of age as a universal guideline for calcium antagonist therapy in hypertension.
Abstract:
The maximum blood pressure (BP) decrease obtained after dose titration with calcium antagonists is said to be greater in older patients. Because the dose necessary to achieve this maximum effect may also vary, it is not clear whether the sensitivity to treatment is actually increased in older patients. We evaluated the possible influence of pretreatment BP, age, and weight on the BP and heart rate (HR) response to 14-day treatment with a fixed dose of 120 mg diltiazem twice daily (b.i.d.) in 231 hypertensive patients aged 24-82 years (44 +/- 27). Diltiazem decreased BP from 171 +/- 1/103 +/- 7 to 156 +/- 1/91 +/- 1 mm Hg. Decreases in both systolic and diastolic BP (SBP, DBP) were related to their pretreatment values (p less than 0.0001 for both). Although pretreatment SBP was related to age (p less than 0.0001), its decrease with diltiazem was not. Neither pretreatment DBP nor its decrease with diltiazem was related to age; BP decrease was not superior in elderly patients (aged greater than 60 years) as compared with that in younger patients (SBP -16 +/- 2 vs. -15 +/- 1 mm Hg, NS; DBP -13 +/- 1 vs. -12 +/- 1 mm Hg, NS). In conclusion, the response to this average dose of diltiazem is related to pretreatment BP and is not affected by patient's age. Because this result is at variance with the concept that calcium antagonists are more effective in the elderly, this concept should not be used as a general therapeutic guideline.