In 15 randomized, double-blind studies with blood pressure measured at the end of the dosing interval,
diltiazem sustained-release or conventional
tablets were found to be equal in efficacy to
hydrochlorothiazide, beta-blockers,
angiotensin-converting enzyme inhibitors, and other
calcium-channel antagonists. The total number of patients with adverse effects and those who drop out due to adverse effects are similar for
diltiazem and the other drugs. Combination
therapy with
diltiazem and
captopril showed additive effects, and combination of
diltiazem with
hydrochlorothiazide or
atenolol showed additional, but perhaps less than additive, effects. Six studies in older and younger patients have shown no overall effect of age on the
antihypertensive effect of
diltiazem. Two studies showed no difference in mean
antihypertensive response between black and non-black patients. In contrast to
diuretics and beta-blockers,
diltiazem does not have adverse metabolic effects on
electrolytes, carbohydrate metabolism, and lipid metabolism.
Diltiazem is an excellent antianginal agent. It has been shown in one study to decrease
proteinuria as effectively as
lisinopril, and it may have renal protective effects. The
antihypertensive efficacy of
diltiazem as monotherapy is equal to that of all other
antihypertensive classes, and it is tolerated as well or better than most other
antihypertensive drugs.
Diltiazem is particularly indicated in patients with
hypertension and concurrent
angina pectoris, diabetes,
hyperlipidemias, and, perhaps,
chronic renal disease.