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Diltiazem, a calcium-channel blocker (CCB), often is used for rate control in patients with atrial fibrillation or flutter, but it also can cause hypotension. Prior studies with verapamil, another CCB, demonstrated that high-dose intravenous calcium pretreatment could prevent hypotension. Data on diltiazem are limited: A 2004 randomized trial showed no change in incidence of hypotension among patients pretreated with 90 mg of elemental calcium (J Emerg Med 2004; 26:395).
In this study from Turkey, researchers randomized 217 adults (mean age, 64) with systolic blood pressure >90 mm Hg who presented with atrial fibrillation or flutter and a ventricular rate >120 beats per minute to receive placebo or 90 mg or 180 mg of elemental calcium (as ca…