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Verapamil improves left ventricular filling and exercise performance in hypertensive and normotensive elderly
R J Petrella1, P M Nichol, D A Cunningham
1Faculty of Medicine, University of Western Ontario, London.
Objective:
To study the effect of verapamil slow release (SR) upon left ventricular diastolic function and exercise capacity in newly diagnosed older hypertensive subjects compared with normotensive elderly and young controls.
Design:
Cross-sectional prospective trial.
Interventions:
Doppler echocardiography at rest and graded maximal exercise testing (with breath-by-breath gas analysis) before and 4 h after administration of oral verapamil SR 240 mg, and before and after 12 weeks of daily medication.
Main Results:
Verapamil administration normalized resting blood pressure in the older hypertensive group, but did not alter blood pressure in older normotensive or young groups. Resting heart rate was not altered in any of the groups. Both the older hypertensive and normotensive groups showed improvement in measures of diastolic filling after verapamil ingestion. Specifically, the older hypertensive group showed significantly faster isovolumic relaxation time (IVRT). In the older normotensive group IVRT was not changed, but the E:A ratio (the ratio of early to late peak transmitral flow velocity) was increased after verapamil. No differences were observed between the effects of verapamil after acute ingestion (4 h) or with chronic use (12 weeks) in any of the variables measured. In the younger group diastolic filling was not altered after verapamil ingestion. In both the elderly normotensive and hypertensive groups maximum oxygen consumption was significantly improved following verapamil ingestion. Again, no differences were observed between 4 h and 12 weeks. In the younger subjects exercise performance was not changed after verapamil ingestion.
Conclusions:
Verapamil SR improved left ventricular diastolic function and exercise performance in hypertensive and normotensive elderly individuals. Verapamil normalized blood pressure in the hypertensive subjects, but did not alter blood pressure in the normotensive elderly or younger subjects.