Antihypertensive effect of verapamil and its effect on blood chemistry during short-term treatment

Verapamil, a calcium channel blacker, was given to 36 [27 females and 9 males] out door patients for three weeks. Mean age was 45 +/- 2 years, mean weight before treatment was 67+2 kg, after treatment it was 64 +/- 3 kg, mean height was 152 +/- 2 cm and mean duration of hypertension was 4 +/- 0.5 years. Mean supine systolic pressure decreased from 169 +/- 3 mmHg to 152 +/- 3.5 mmHg [p<0.001] while supine standing pressure dropped from 171 +/- 4.6 mmHg to 156 +/- 3.8 mmHg [p<0.05]. Mean supine diastolic pressure decreased from 107 +/- 1 mmHg to 93.7 +/- 1.8 mmHg [p<0.001] while erect diastolic pressure decreased from 113 +/- 1 mmHg to 100 +/- 2.2 mmHg. [p<0.001] Mean supine arterial pressure decreased from 128 mmHg to 113 mmHg while standing mean arterial pressure decreased from 133 mmHg to 119 mmHg. No statistically significant fall in heart rate both in supine and standing position was observed. Laboratory results did not show any variation. In 69% of the patients with supine systolic pressure was < /- 150 mmHg while in 66% of the patients supine diastolic pressure was <90 mmHg. Verapamil is found to be effective and safe as monotherapy in mild to moderate hypertension

Calcium channel blockers and bradyarrhythmias

Two hundred and eleven patients out of 350 patients admitted to Coronary Care Unit at Mayo Hospital, Lahore were put on calcium channel blockers. Conduction defects and haemodynamic effects of calcium channel blockers alone or in combination with beta-blockers were observed. Eight patients on Diltiazem developed bradyarrhythmias In four patients Diltiazem was omitted due to hypo-tension and bradyarrhythythmias. In other four patients dose was reduced from 270 mg per day to 90 mg per day to abolish the bradyarrhythmias. One patient on Verapamil developed bradyarrhythmia which was reverted to sinus rhythm after reducing the dose. None of the patients on Nifidipine developed any conduction defect. Six patients on Diltiazem who had bradyarrhythmias were admitted with unstable angina. We conclude that Diltiazem should be used carefully in patients having unstable angina