EFFECT OF VERAPAMIL SUSTAINED RELEASE ON CEREBROVASCULAR REACTIVITY IN HYPERTENSIVE PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Objective: To investigate the effect of verapamil sustained release (SR) on cerebrovascular reactivity (CVR) in patients with hypertension (HT) and rheumatoid arthritis (RA). Design and method: The study comprised 30 patients with HT of grade 1-2 and RA, aged 59.7 ± 9.1 years. All patients were treated with 120 mg or 240 mg verapamil SR for 24 weeks. Ambulatory 24-hour blood pressure (BP) monitoring and evaluation of CVR were performed twice: initially and at the end of the study. CVR was evaluated using transcranial Doppler ultrasound of the middle cerebral arteries (MCA) in the hyperoxia and hypercapnia tests. We measured MCA time average maximal blood flow velocity (TAMX), peak systolic velocity (Vps) at baseline, during 2 min inhalation of oxygen (O2) and during 3 min recovery phase. The hypercapnia test was carried out according to the same protocol with inhalation of the 4% mixture of carbonic gas with air (CO2). We used three parameters for CVR evaluation: index changes of flow velocity mean (IFVm), speed modification of velocity (SMFVm) and index of recovery for velocity (IRVmrec). IFVm = (Vps2–Vps0)/Vps0*100%. SMFVm = (Vps2-Vps0)/120. IRVmrec = Vps0/Vps4. Vps0 is starting parameter. Vps2 is the parameter during 2 minute of inhalation. 120 is time of inhalation in seconds. Vps4 is the parameter during 4 minutes of test. The differences in BP values and parameters for CVR evaluation were tested with Student's t-test for paired samples. Results: Verapamil SR treatment reduced both systolic/diastolic office and 24-h BP by 14.1/8.2 mmHg for office BP and 13.5/9.9 mmHg for 24-h BP, all P < 0.0000. After Verapamil SR treatment, the parameters of MCA blood flow and CVR did not change either in the hyperoxia or in the hypercapnia tests compared with those before treatment. Conclusions: Treatment with verapamil SR did not improve the parameters of CVR in hypertensive patients with RA.