Hypertension with orthostatic hypotension: interest of verapamil.
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.
Chamontin
B F
BF
Department of Internal Medicine, C.H.U. Purpan, Toulouse, France.
Montastruc
J L
JL
Salvador
M J
MJ
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D004294:Domperidone / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007024:Hypotension, Orthostatic / Q000150:complications; D008297:Male; D008875:Middle Aged; D014700:Verapamil / Q000627:therapeutic use*
D004294:Domperidone; D014700:Verapamil