Lege Artis Medicinae

[Verapamil treatment in hypertension]


JUNE 30, 1992

Lege Artis Medicinae - 1992;2(01 KLSZ)

[The author describes the mechanisms of action of verapamil, the first calcium antagonist, and also shortly summarizes its indications and ways of administration in hypertension. Its role in antihypertensive combinations and interactions are also conscisely dealt with.]


  1. Fővárosi Szent Imre Kórház I. sz. Belgyógyászat Budapest



Further articles in this publication

Lege Artis Medicinae

[The calcium channel blocker verapamil basic properties, pharmacokinetics, interactions, side effects]


[The family of calcium channel blockers is very large and includes its prototype, the monophenylalkylamin drug, verapamil. It is a non-selective vasodilator which exerts a powerful effect equally on myocardium, conducting and nodal tissue of the heart, and both central and peripheral vasculature. Verapamil is almost completely absorbed after oral administration. However, because of extensive first-pass hepatic metabolism, only about 20% of the drug is bioavailable. The elimination phase is slow with a half-time varying from 5 to 7 hours. Orally administered verapamil is extremely well tolerated drug with a very low incidence of gastric intolerance, constipation, vertigo, facial flushing headache and pruritus. During intravenous administration the most common side effects are hypotension and and occasional AV conduction disturbances, or bradycardia. Main contraindications are listed. Coadministration of beta receptor blokers, digitalis and disopyramid should be avoided. ]

Lege Artis Medicinae

[Effects of verapamil on cardiac arrhythmias]


[Verapamil, a „first generation" calcium anta gonist and synthetic papaverine derivate, was initially introduced as a potent peripheral and coronary vasodilator. It was later found to have significant antiarrhythmic activity, the mechanism of which was related to selective inhibition of transmembrane fluxes of the calcium. The electrical activity of the sinus node and of the atrioventricular (AV) node depends primarily on slow inward Ca2+ currents, therefore it is logical to expect that calcium antagonists will be effective here. The main electrophysiologic effects of verapamil include the slowing of conduction and the prolongation of refractoriness in the atrio ventricular node without significantly affecting intraatrial or intraventricular conduction. Thus, verapamil has been effective in the acute termination of reentry tachycardia in volving the atrioventricular node and in slowing the ventricular response during atrial fibrillation or flattern. Since verapamil has little, if any, effect on the electrical activity of the ventricle or the His Purkinje system, it does not provide effective therapy for controlling ventricular tachycardias. This paper focuses on a detailed discussion of the various arrhythmias that respond to calcium antagonist therapy. ]

Lege Artis Medicinae

[Antianginal effects of verapamil]


[Verapamil is the prototype of the calcium antagonists. Administration of the drug produces a beneficial antianginal effect due to de creased preload and afterload through vasodilation without marked reflex tachycardia and also due to a special influence on myocardium (negative inotropy and positive lusitropy) in all forms of ischaemic heart disease. Verapamil is also a strong coronary dilator drug. Verapamil was given in doses of 240–360 mg daily. The investigators concluded that exercise tolerance increased and the number of anginal attacks and nitroglycerin (sublingual) consumption decreased. The rate-pressure product is reduced on verapamil. Its cardio protective effect on myocardial structure is still an object of discussion.]

Lege Artis Medicinae

[Verapamil treatment in hypertrophic cardiomyopathy]


[The main aims of therapy in hypertrophic cardiomyopathy, in which ways the symptoms of the patients can be decreased and their survival can be made longer, are as follows: to ameliorate the impaired ventricular relaxation during diastole, to decrease or abolish the obstruction to the left ventricular outflow in systole, as well as to prevent or abolish the atrial and ventricular arrhythmias. Verapamil treatment can be advantageous in each of the above respect. The author describes the characteristics and pathophysiology of the disease in order to understand the favourable effects of Verapamil. On the basis of the literature he gives an outline of the experiences attaining with the application of the drug. He makes the reader acquainted with the results of follow-up studies and with his own observations treating 35 patients with verapamil.]

Lege Artis Medicinae

[Application intravenous verapamil in hypertonic crises]

NAGY Viktor, ISKUM Miklós

[Hypertensive crisis becomes manifest in two clinically well distinguishable forms. Life threatening cases require immediate intervention, while in cases not immediately life threatening, the situation is less critical, but a delay in treatment may lead to serious organ damage. The authors administered 5 mg verapamil intravenously during 3 minutes to 46 patients (mean age 65,7 years, 31 women, and 15 men). The initial blood pressure of 226/125 mmHg decreased to 193/97 mmHg, and the heart rate decreased from 98/min to 81/min three minutes following the injection (p < 0,01 at both parameters). No significant change was observed in either the blood pressure or the heart rate during the subsequent 30 minutes. As a side-effect, flushing was observed in two cases. Based on the literature and their own experiences, the authors recommend intravenous verapamil as the drug of choice for life-threatening hypertensive crises associated with angina pectoris and cerebrovascular circulatory disorder in cases where EKG is available. ]

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[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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[Association between cyclothymic affective temperament and hypertension]


[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Hypertension and nephrology

[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]


[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

Lege Artis Medicinae

[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]


[Chronic obstructive pulmonary disease is a very common comorbidity of hypertension and it is often unrecognised by physicians. The factors involved in the pathomechanism of both diseases should be realised when choosing treatment. Among factors, hypoxia, increased tone of sympathetic nervous system and activation of renin-angiotensin-aldosterone system should primarily be considered. Vascular wall damage and endothelial dysfunction has an important role in both conditions. The goals of treatment are elimination of risk factors, optimizing the blood pressure, the consequential prevention of cardio-cerebrovascular, renal and pulmonary damage; finally prolonging the patients’ life and improving their quality of life as well. Both hypertension and COPD significantly worsen the condition of COVID-19 patients since they increase the severity of the disease and the rate of in-patients’ and their mortality. In the treatment of hypertension among COPD and COVID-19 patients there must be emphasized the medication inhibiting of renin-angiotensin-aldosterone system, such as angiotensin-converting en­zyme inhibitors or angiotensin-II AT1 re­cep­tor antagonists. Special attention concerned the beneficial effect of mineralocorticoid receptor antagonist spironolactone. Other antihypertensive drugs (calcium channel blockers, thiazide-like diu­retics, high selectivity β1 receptor antagonists) may supplement the treatment if necessary. Long-acting β2 receptor agonists, muscarinic receptor antagonists and inhalation corticosteroids may be administered in double or triple combination also in hypertension and COPD as well. It is important to note, that statin therapy and also vitamin D3 improve the condition of COVID-19 patients.]

Hypertension and nephrology

[May measurement month: analysis of the Hungarian results of years 2017 and 2019]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Cardiovascular (CV) diseases are not only the leading causes of mortality in Hungary, but also the mortality rate is excessively high compared with the average of European Union, so screening programs identifying subjects with elevated blood pressure (BP) is of utmost importance. May Measurement Month (MMM) is an annual global initiative which began in 2017 aimed at raising awareness of high BP. Hungary, through the Hungarian Society of Hypertension has joined the campaign of MMM from the beginning. The results of years 2017 and 2019 are presented in this paper. ]