Calcium channel blockers are increasingly used to treat hypertension in elderly patients. To assess the effects of low-dose, long-acting verapamil on blood pressure (BP) and quality of life (QOL) in elderly patients, verapamil 120-240 mg of placebo was given once daily for 8 weeks to 76 patients aged > or = 60 years. After a 4-week placebo wash-out period, patients with a sitting DBP of 95-110 mm Hg and a mean daytime (6 am to 6 pm) ambulatory DBP > or = 90 mm Hg were entered into the study. Twenty four-hour BP monitoring as well as QOL self-assessment and digit span testing of cognitive function were performed at the end of the placebo wash-out and double-blind treatment periods. Patients treated with verapamil showed a significant decrease in mean whole-day BP, while those treated with placebo showed a small increase in BP. Treatment differences between the two groups in SBP and DBP were each statistically significant (P < 0.01). Significant differences were also seen when the 24 h period was divided into daytime and night-time readings. Both QOL and digit span testing scores were unchanged from baseline for verapamil-treated patients and were not different from the placebo-treated group. The results of this study demonstrate consistent and significant decreases in BP throughout the 24 h period with no adverse effects on QOL or cognitive function this this formulation of verapamil in elderly hypertensive patients.