Verapamil Use in Hypertension

Indications and Usage

• The American Heart Association recommends verapamil for patients with hypertension and angina, especially when beta blockers are contraindicated or produce intolerable side effects 1, 2
• The American College of Cardiology suggests initiating verapamil with low doses and titrating up to 480 mg/day for symptom treatment in patients with hypertension who do not respond to beta blockers 3
• Verapamil is indicated for patients with hypertension and supraventricular tachycardias, as it decreases sinus node frequency and slows atrioventricular nodal conduction 6
• The European Society of Cardiology recommends verapamil for patients with hypertension and cardiomyopathy, as it improves ventricular filling by increasing diastole duration through heart rate reduction 3, 5

Contraindications and Precautions

• The American Heart Association advises against using verapamil in patients with left ventricular systolic dysfunction or heart failure 7, 8
• Verapamil should be avoided in patients with hypotension, significant sinus or atrioventricular node dysfunction, or advanced cardiac block without a pacemaker 9
• The combination of verapamil and beta blockers should be used with caution due to the increased risk of significant bradyarrhythmias and heart failure 1, 2

Dosage and Administration

• The American College of Cardiology recommends starting with low doses and titrating according to clinical response, up to a maximum of 480 mg/day 3