Correlation between verapamil plasma concentration and P-R prolongation in essential hypertension

Plasma verapamil concentration was correlated with serial electrocardiographic P-R intervals in patients with essential hypertension receiving immediate-release (80 to 120 mg three times a day) or sustained-release (240 mg daily) verapamil. The mean P-R interval in 22 patients taking placebo and immediate-release verapamil was 0.18 second. The borderline first-degree atrioventricular block of three patients did not change during treatment. Plasma verapamil concentrations of patients with a P-R interval longer than 0.20 second and of those with a P-R interval of 0.20 second or less were 169 +/- 73 ng/mL and 63 +/- 8 ng/mL, respectively. Six patients taking sustained-release verapamil had a maximal mean P-R interval of 0.19 +/- 0.01 second during 24-hour ambulatory electrocardiographic monitoring. P-R intervals were 0.22 second or more in two patients, but they returned to normal by hour 7 for one and by hour 20 for the other patient. In summary, transient P-R prolongation occurred with oral verapamil therapy, but no patient, regardless of baseline P-R interval, developed high-grade atrioventricular block.