Related Experiment Videos
Hypertension with orthostatic hypotension: interest of verapamil
B F Chamontin1, J L Montastruc, M J Salvador
1Department of Internal Medicine, C.H.U. Purpan, Toulouse, France.
Insights
Verapamil, a calcium channel blocker, effectively manages hypertension without worsening orthostatic hypotension. This study suggests verapamil may improve baroreflex sensitivity in patients with both conditions.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Orthostatic hypotension (OH) poses challenges in managing hypertension.
- Calcium channel blockers (CCBs) are common antihypertensives, but their effect on OH is not fully understood.
Purpose of the Study:
- To investigate the efficacy of verapamil in hypertensive patients with symptomatic orthostatic hypotension.
- To assess verapamil's impact on blood pressure and orthostatic symptoms.
Main Methods:
- Open-label study involving six hypertensive patients with OH.
- Verapamil administered at 240-360 mg/day for six months.
- Blood pressure and heart rate monitored in lying and standing positions.
Main Results:
- Verapamil significantly reduced blood pressure (lying and standing).
- Verapamil did not worsen orthostatic hypotension; standing blood pressure decrease was not impaired.
- Verapamil increased baroreflex sensitivity from 1.4 to 3.5 ms/mm.
Conclusions:
- Verapamil is a promising option for managing coexisting hypertension and orthostatic hypotension.
- Verapamil may enhance baroreflex sensitivity, potentially benefiting patients with OH.
Abstract:
The purpose of this study was to investigate the effects of the calcium channel blocker verapamil in the management of patients with both high blood pressure and orthostatic hypotension. Six hypertensive patients, aged 37-78 years, mean 60.8 +/- 3.2 years, four men and two women, with symptomatic orthostatic hypotension were included in this open study. Verapamil, 240 to 360 mg/day, decreased blood pressure and did not impair orthostatic hypotension with a mean follow-up of 6 months. Blood pressure and heart rate were, in lying and standing position, respectively, as follows: 177.5 +/- 5.9/99.1 +/- 9.9 mm Hg and 81.0 +/- 9.0 beats/min and 120.0 +/- 4.8/83.3 +/- 4.0 mm Hg and 91.0 +/- 9.5 beats/min before treatment; then, 155.8 +/- 5.5/89.1 +/- 4.2 mm Hg and 74.5 +/- 8.6 beats/min and 127.5 +/- 7.3/83.3 +/- 4 mm Hg and 83.0 +/- 9.1 beats/min after verapamil. In three patients with orthostatic hypotension successfully treated by the peripheral dopaminergic antagonist domperidone 60 mg/day, the subsequent introduction of verapamil 240 mg/day did not modify the standing-induced decrease in systolic blood pressure: 46.6 mm Hg under domperidone and 30.0 mm Hg under domperidone plus verapamil. Verapamil increased baroreflex sensitivity from 1.4 to 3.5 ms/mm in all patients. This preliminary study shows the interest of verapamil in the difficult management of hypertension with orthostatic hypotension. It is suggested that verapamil could increase the baroreflex sensitivity in patients with orthostatic hypotension.