Administration-Time-Dependent Effects of Diltiazem on the 24-Hour Blood Pressure Profile of Essential Hypertension Patients

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Abstract
The aim of this study was to identify differences in the patterns of efficacy and duration of effect by diltiazem given in different dosage forms and schedules. Blood pressure (BP) and heart rate (HR) were monitored before and after treatment by ambulatory blood pressure monitoring for 48 h every 30 min. Patients were divided for treatment assignment into 4 groups—nocturnal BP dippers and nondippers. In dipper hypertension, diltiazem-retard at 08:00 (n = 7) had the most marked antihypertensive effects during nighttime rest (SBP; 136 ± 14/118 ± 9 mmHg, p < 0.01 before vs. after treatment). Diltiazem-retard at 19:00 (n = 6) exerted greatest effect during daytime activity (152 ± 7/139 ± 6, p < 0.01) with inhibition of the morning BP rise. Diltiazem (t.i.d., n = 5) had the best effect during daytime activity (151 ± 16/136 ± 9, p < 0.05). However, in nondipper hypertensive patients, diltiazem (t.i.d., n = 8) had the most pronounced antihypertensive effects during nightly rest (144 ± 12/127 ± 12, p < 0.05). Evening medication with diltiazem retard appears to be more efficacious than the other dosage schedules.