Sustained-Release Diltiazem and Prevention of Cardiovascular Risk in Hypertensive Patients

The prevention of coronary disease in hypertensive patients will see progress in the years to come. It is clearly too much, however, to expect this progress to come exclusively from the application of new therapies, as the incidence of coronary disease in hypertensive patients depends on several factors, which are, essentially, the persistence and severity of hypertension and the major cardiovascular risk factors associated with arterial hypertension, including hypercholesterolemia, diabetes, and nicotine abuse. Which new solutions to this problem can a novel therapy for arterial hypertension using calcium antagonists in general and diltiazem in particular thus provide? The majority of patients consulting their doctor for arterial hypertension also present with other risk factors associated with increased blood pressure, mostly hypercholesterolemia and diabetes. The antihypertensive efficacy of diltiazem can no longer be doubted; moreover, diltiazem monotherapy with single daily doses is of great advantage for compliance in hypertensive patients. As diltiazem has been in use for more than 10 years and its dosage has been gradually diminished, the risk of a new long-term iatrogenic pathological process is becoming less and less conceivable. Sustained-release diltiazem is effective as monotherapy at single daily doses of 300 mg as evidenced by an effect/dose study in 105 patientsDBP = −17 mm Hg with 300 mg (72% of the patients responded to this dosage). Sustained-release diltiazem 300 mg has the same potency as enalapril given at daily doses of 20 mgDBP = −19.8 mm Hg for diltiazem vs. −11.3 mm Hg for enalapril, SBP = −22 mm Hg for diltiazem vs. −20.3 mm Hg for enalapril. Sustained-release diltiazem 300 mg is equally effective and better tolerated than a diuretic in elderly patients over 65 years of ageDBP = −18.1 mm Hg for diltiazem vs. — 13.07 mm Hg for the diuretic, SBP = −28.1 mm Hg for diltiazem vs. —25 mm Hg for the diuretic (75% of the patients were responders in the diltiazem group vs. 50% in the diuretic group). Sustained-release diltiazem 300 mg allows better 24-h control of blood pressure due to its new galenic formula. The cardiac effects of sustained-release diltiazem reduce the incidence of coronary diseases through secondary prevention (Gibson et al.). Experimental results also suggest its efficacy in primary prevention. Finally, due to its nonexistent or beneficial metabolic effects, diltiazem may be preferable to other equally effective medic