Journal of Postgraduate Medicine
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ORIGINAL ARTICLE
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Year : 1990  |  Volume : 36  |  Issue : 1  |  Page : 5-8  

Effect of intravenous infusion of verapamil in patients of severe hypertension.

SK Verma, R Dosi, SK Kaushik, A Bordia 
 Department of Medicine (Cardiology), R.N.T. Medical College, Udaipur.

Correspondence Address:
S K Verma
Department of Medicine (Cardiology), R.N.T. Medical College, Udaipur.

Abstract

Thirty patients with diastolic blood pressure of 120 mm Hg or more were administered a bolus dose of verapamil (0.15 mg/kg) followed immediately by an intravenous infusion at a rate of 0.005 mg/kg/min for one hour. The patients were monitored during this period and three hours following the discontinuation of the infusion. The systolic, diastolic and mean blood pressures before verapamil administration were 221.4 +/- 7.5, 134.3 +/- 2.7 and 163.4 +/- 4.1 mm Hg respectively, which decreased to 170.1 +/- 5.2, 99.1 +/- 3.7 and 122.8 +/- 3.6 mm Hg after intravenous bolus of verapamil. The fall in all the levels of blood pressure was significant (p less than 0.001) and was maintained at the lower levels throughout the infusion period and even three hours after discontinuation of the therapy. No untowards effects were observed and there was no significant change in heart rate and electrocardiogram. It, thus, proves to be an useful addition to the therapeutic armamentarium in the acute management of severe hypertension.



How to cite this article:
Verma S K, Dosi R, Kaushik S K, Bordia A. Effect of intravenous infusion of verapamil in patients of severe hypertension. J Postgrad Med 1990;36:5-8


How to cite this URL:
Verma S K, Dosi R, Kaushik S K, Bordia A. Effect of intravenous infusion of verapamil in patients of severe hypertension. J Postgrad Med [serial online] 1990 [cited 2020 Apr 5 ];36:5-8
Available from: http://www.jpgmonline.com/text.asp?1990/36/1/5/871


Full Text




  ::   IntroductionTop


Hypertension remains the major risk factor for coronary, cerebral and renal vascular diseases, which are responsible for death and disability among adults. There are very few anti-hypertensive drugs freely available in our country for the management of hypertensive emergencies. Verapamil (Isoptin), a calcium channel blocker lowers blood pressure by relaxing smooth muscle at arteriolar level{10]. It has been used both intravenously{10], for its immediate anti-hypertensive effect and orally{8],{11] for long-term management. However, there are very few studies where verapamil has been given intravenously for the management of severe hypertension in our country. In view of this, the present study was designed to observe the effect of continuous intravenous infusion of verapamil in patients of severe hypertension, where immediate control of blood pressure is desired.


  ::   Material and methodTop


Thirty hypertensive patients of either sex (20 males and 10 females) between the ages of 30 to 70 years were selected who had,

a) diastolic blood pressure 120 mm Hg or more, and

b) not been receiving any anti-hypertensive drugs during the last two weeks.

Patients with congestive heart failure, severe bradycardia, high grade A-V block, liver disease and those who were receiving beta blockers were excluded from the study.

After interrogation, each patient was subjected to a thorough clinical examination including fundoscopy. The investigations included serum creatinine, serum electrolytes, blood sugar, blood urea, serum cholesterol, liver function tests and X-ray chest. A standard twelve leads electrocardiogram (ECG) was recorded before initiation of the study.

The study was conducted with patients in supine position. Blood pressure was recorded by the standard cuff method using mercury manometer, and diastolic pressure was taken at phase five of the Kortokoff's sound.

Blood pressure and pulse were recorded at 5 minute intervals till three consecutive identical recordings were obtained. Two ml of 5% glucose was then injected intravenously over three minutes in the other arm followed by recording of pulse and blood pressure at an interval of 1, 2, 5 and 10 minutes.

Bolus dose of verapamil (0.15 mg/kg) was injected over a 3 minute period and immediately followed by infusion of verapamil in 500 ml of 5% glucose at a rate of 0.005 mg/kg min. It was continued for 1 hour. Pulse and blood pressure were recorded just after the bolus and then subsequently at 2, 5, 10, 15, 30, 45 and 60 minutes. E.C.G. monitoring was carried out. After discontinuation of the infusion of verapamil, pulse, blood pressure and E.C.G. monitoring were continued and recordings were obtained at 10, 20, 30, 60, 120 and 180 minutes. All the patients were enquired about development of any side effects.


  ::   ResultsTop


Of the thirty patients included in the trial 4 had renal hypertension, while no aetiology was found for the rest. In the latter group 12 had sustained hypertension, 7 had accelerated and 7 presented with malignant hypertension. Of the 4 patients with renal hypertension, 2 had sustained and 2 had malignant hypertension.

The mean values for blood pressure were 221.4 + 7.5 mm Hg systolic (range being 160 to 270 mm 1-1g) and 134.3 + 2.7 mm Hg diastolic (range: 120 to 170 mm Hg).

Intravenous bolus administration of verapamil decreased systolic blood pressure from 221.4 + 7.5 to 170.1 + 5.2 and diastolic blood pressure from 134.3 + 2.7 to 99.1 + 3.7 (p < 0.001). This fall in blood pressure was maintained for the entire duration of the study (Table 1) and even upto 3 hours after discontinuation of the infusion (Table 1). The heart rate remained more or less stationary (Table 2) throughout the study. No change was found in ECG.


  ::   DiscussionTop


Hegino{6] first reported anti-hypertensive effect of verapamil, following which several trials have been conducted to establish its place in therapy of hypertension{8],[10],[11]. Brittinger et al{3] demonstrated a fall in systolic and diastolic blood pressure by 24 and 22 per cent respectively within the first minute following a single intravenous bolus administration of 5 mg verapamil. Others{1],{9],[10] have also observed therapeutically useful reduction in severe hypertension following 5 mg of verapamil intravenously.

The present study also confirmed that after the bolus dose, the drug produces a significant fall in blood pressure and this effect is predictable.

The significant fall in blood pressure achieved after a single intravenous bolus was maintained when the drug was given as a continuous intravenous infusion for one hour without any side effects. There are only few reports that indicate its usefulness as an infusion to maintain the desirable level of blood pressure in severe hypertension{4],{7]. In a recent study{2] on 10 patients with systemic blood pressure of 170/110 mm Hg or more, a significant fall in systolic and diastolic blood pressure was observed in all the patients after an intravenous bolus and the desirable anti-hypertensive effect was maintained with infusion without side effects.

The present study demonstrates that even after stopping the intravenous infusion, the blood pressure remained at a lower level for 3 hours, suggesting that the action of drug persists for quite a long time. Throughout the study, there were neither any significant alterations in the heart rate nor the ECG revealed any change in PR interval or appearance of any conduction disturbances.

Verapamil, thus appears to be an effective and well tolerated anti-hypertensive agent which can be given intravenously as well as orally, has dependable action, is easily available and does not need intra-arterial and intravenous pressure monitoring systems. It therefore offers a useful addition to the therapeutic armamentarium in the acute management of severe hypertension.

References

1 Bender R. Treatment of tachycardia, arrhythmias and arterial hypertension with verapamil. Arzneim Forsch. Quoted by Lewis et al {8]. 1970; 20:1310.
2Bhat RP, Wasir HS. Verapamil infusion in hypertension, Ind Heart J 1981; 34:228-231.
3Brittinger WD, Schwambeck A, Witteneier KW, Twittenhoff WD, Stegaru B, Huber W, Ewald RW, Herming GE, Fabricus M, Strauch M, et al. Clinical trial of the hypotensive effect of verapamil. Deutsch Med Wschr Quoted by Lewis et al {8]. 1970; 95:1871-1877.
4Dickmann L, Hosemann R. Anti-hypertensive effect of verapamil - Investigations and experiences in children. Munch Med Wochenschr 1974, pp 116:515.
5Haeusler G. Differential effects of verapamil on excitation - contraction coupling in smooth muscle and on excitation - secretion coupling in adrengic nerve terminals, J Pharmacol Exp Therp 1972; 180:672-682.
6Hegino K. Application of lproveratril in the pharmotherapy of hypertension. Jap J Clin Exp Med 1968; 45:208.
7Lee SS, Chaiang HT, Chiang BN. Symposium on, "Treatment of hypertensive emergency with diazoide, sodium nitroprusside and verapamil. Clinical and hemodynamic observations." Taiwan Veterns General Hospital, Division of Cardiology, Kachriung, Taiwan, August 1975.
8Lewis GRJ, Morley KD, Lewis BM, Bones PT. Treatment of hypertension with verapamil. Newzealand Med J 1978; 87:351.
9Scharer K, Alatas H, Bein G. Treatment of renal hypertension with verapamil in childhood. Mschr Kinderheilk Quoted by Zawar et al. 1977; 125:706.
10Wasir HS, Kasliwal RR, Bhatia ML. Immediate effect of intravenous verapamil in hypertension. Ind Heart J 1979; 311: 326-329.
11Zawar PB, Chawhan RN, Gosavi SV, Gokhale PD, Jadhav AB. Verapamil in hypertension - a long-term study. Ind Heart J 1982; 34:38-41.

 
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