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Verapamil may have benefits beyond lowering blood pressure

NEW YORK (Reuters Health) – In contrast to amlodipine, verapamil may benefit patients by effectively restoring short-term autonomic control of blood pressure in addition to lowering blood pressure, according the results of the VAMPHYRE study.

In a double-blind crossover study, Dr. Johan D. Lefrandt from the University Hospital of Groningen, The Netherlands, and colleagues randomly assigned 145 patients, with diastolic blood pressures between 95 and 110 mm Hg, to 8 weeks of treatment with verapamil sustained release 240 mg/day or amlodipine 5 mg/day, after 4 weeks of placebo.

During both phases of the trial, each of the drugs effectively reduced blood pressure from baseline levels of 153/100 mm Hg to 139/91 mm Hg (verapamil) and 138/91 mm Hg (amlodipine). Sympathovagal balance, measured by the low- to high- frequency ratio, was higher with amlodipine (4.66) compared with verapamil (4.10) p = 0.001), the researchers note.

However, although both medications improved baroreflex function, verapamil significantly improved baroreflex sensitivity (8.47 msec/mm Hg) compared with amlodipine (8.06 msec/mm Hg, p = 0.01). Also, norepinephrine levels were higher with amlodipine (1.59 nmol/L) compared with verapamil (1.32 nmol/L), according to the report in the November issue of the American Journal of Hypertension.

Dr. Lefrandt and colleagues conclude that "long-acting dihydropyridine amlodipine induces a shift in sympathovagal balance…toward sympathetic predominance compared with vagal predominance with non-dihydropyridine verapamil and short-term autonomic control of blood pressure…is more effectively restored by verapamil than by amlodipine."

"These contrasting effects of calcium antagonists of different classes may have therapeutic implications beyond lowering blood pressure," they add. "However, further long-term studies are needed to determine whether reduction of sympathetic tone and restoration of baroreflex function can reduce the risk of complications and mortality in hypertension."

Am J Hypertens 2001;14:1083-1089.

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