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It does this by blocking 'calcium channels' on these muscle cells. Calcium is needed by the muscle cells in order for them to contract. By depriving them of calcium, diltiazem causes the muscle cells to relax. This action of diltiazem has two main effects; it slows down the rate at which the heart beats and it allows the blood vessels in the body to widen. When the heart beats more slowly, the pressure at which the blood is pumped out of the heart is reduced. When the blood vessels in the body relax and widen, this decreases the resistance that the heart has to push against in order to pump the blood around the body. Both these actions reduce the pressure within the blood vessels. This means diltiazem can be used to lower high blood pressure. Slowing the heart rate also reduces the energy used by the heart to pump blood around the body. This in turn reduces the heart's need for oxygen. At the same time, widening the blood vessels improves the blood and therefore oxygen supply to the heart. Both these features mean that diltiazem can be used in the management of angina. The chest pain of angina is caused by insufficient oxygen supply to the heart. As diltiazem improves this oxygen supply, and also reduces the effort the heart has to make to pump blood, it can be used to prevent angina attacks. Diltiazem capsules are a long-acting or 'modified-release' form of diltiazem. This means that they are designed to release the diltiazem slowly and continuously over several hours to produce a steady blood level of the medicine throughout the day. Diltiazem capsules are designed to be taken once a day, at the same time each day. They should be swallowed whole and not chewed or crushed, as this would damage the modified-release action. 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