Antihypertensive and anti-ischemic effects of diltiazem in patients with primary hypertension.

Hypertension is a well-established risk factor for myocardial ischemia, which may often remain asymptomatic. This study aims to evaluate the effects of diltiazem on blood pressure and myocardial ischemia in patients with grade I-II primary hypertension. Between January 2018 and April 2022, 160 patients diagnosed with mild to moderate primary hypertension were enrolled. Patients were assigned to 1 of 4 treatment groups: benazepril monotherapy group (benazepril 10 mg/day, n = 44); irbesartan monotherapy group (irbesartan 150 mg/day, n = 45); diltiazem monotherapy group (diltiazem hydrochloride sustained-release tablets 90 mg/day, n = 36); and combination therapy group (diltiazem hydrochloride sustained-release tablets 90 mg/day plus either benazepril 10 mg/day or irbesartan 150 mg/day, n = 35). Systolic and diastolic blood pressure were recorded at baseline and post-treatment. Myocardial ischemia was assessed using 24-hour Holter electrocardiogram monitoring, and the total ischemia burden (TIB) was calculated as the cumulative duration of ST-segment depression. All treatment groups demonstrated statistically significant reductions in both systolic and diastolic blood pressure following intervention (P < .05). The combination therapy group exhibited a significantly greater reduction in diastolic blood pressure compared to the diltiazem monotherapy group (P < .05). TIB significantly decreased in the diltiazem monotherapy, benazepril monotherapy, and combination therapy groups (P < .05), whereas the reduction observed in the irbesartan monotherapy group was not statistically significant. Additionally, the benazepril monotherapy group demonstrated a significantly greater reduction in TIB compared to irbesartan (P < .05). Diltiazem effectively reduced both systolic and diastolic blood pressure and demonstrated anti-ischemic properties. Combination therapy with diltiazem and other antihypertensive agents, particularly benazepril, may offer additional therapeutic benefits. These findings support the potential role of diltiazem in the management of patients with mild to moderate hypertension and subclinical myocardial ischemia.