From the Guidelines
Cardizem (Diltiazem) should be held if the systolic blood pressure (SBP) falls below 90 mmHg, as this threshold is generally considered a safe limit to avoid hypotension and ensure adequate organ perfusion. When managing patients on Cardizem, it's crucial to monitor their blood pressure closely, especially in those with coronary artery disease or heart failure, as significant hypotension can exacerbate myocardial ischemia and worsen heart failure symptoms 1. The American Heart Association recommends targeting a blood pressure of <140/90 mm Hg, but also suggests considering lower targets, such as <130/80 mm Hg, in certain patient populations 1. However, in the context of holding Cardizem, the primary concern is avoiding hypotension, rather than achieving a specific blood pressure target. Key considerations in clinical practice include:
- Monitoring for signs and symptoms of hypotension, such as lightheadedness, dizziness, and altered mental status
- Adjusting the threshold to hold Cardizem based on individual patient factors, such as baseline hypotension or symptomatic hypotension at higher blood pressures
- Notifying the prescribing provider when a dose is held, to allow for reevaluation of the medication regimen. In older adults, particularly octogenarians, it's essential to assess for orthostatic changes and avoid SBP <130 mm Hg and DBP <65 mm Hg 1. Ultimately, the decision to hold Cardizem should be based on a careful assessment of the patient's individual risk factors and clinical presentation, with a focus on minimizing the risk of hypotension and ensuring optimal organ perfusion.
From the FDA Drug Label
• Patients with hypotension (less than 90 mm Hg systolic) The systolic blood pressure at which you should hold Cardizem (Diltiazem) is less than 90 mm Hg 2.
From the Research
Systolic Blood Pressure Threshold for Holding Cardizem (Diltiazem)
- The studies provide evidence on the efficacy and safety of diltiazem in managing atrial fibrillation with rapid ventricular rate (RVR) and hypertension, but do not specify a clear systolic blood pressure (SBP) threshold for holding Cardizem (Diltiazem) 3, 4, 5, 6, 7.
- However, one study defines hypotension as a systolic blood pressure (SBP) < 90 mm Hg, with an 18% prevalence of reported diltiazem-induced hypotension 3.
- Another study reports that the lowest recorded SBP within 240 minutes of diltiazem was 90 mmHg, but does not specify a threshold for holding the medication 6.
- Based on these findings, it can be inferred that an SBP of < 90 mmHg may be a threshold for caution when administering diltiazem, but this is not explicitly stated as a threshold for holding the medication.
Key Findings
- Diltiazem is effective in reducing heart rate and blood pressure in patients with atrial fibrillation with RVR and hypertension 3, 4, 5, 6, 7.
- The medication is generally well-tolerated, but can cause hypotension and other adverse effects 3, 4, 5, 6, 7.
- The optimal dosing strategy for diltiazem is still a topic of debate, with varying doses and administration schedules used in different studies 3, 4, 6.