Key result
A single 40 mg predialysis dose of verapamil had no effect on intradialytic blood pressure, with 0.99 episodes of symptomatic hypotension per session compared to 0.93 with placebo (p<0.05).
Why the study?
Does a single predialysis dose of verapamil improve intradialytic blood pressure or reduce symptomatic hypotension in chronic hemodialysis patients?
RCT (n=10)
Double-blind
Does a single predialysis dose of verapamil improve intradialytic blood pressure or reduce symptomatic hypotension in chronic hemodialysis patients?
Absolute Event Rate: 0.99% vs 0.93%
p-value: p=<0.05
A single predialysis dose of verapamil does not improve intradialytic blood pressure and may slightly increase symptomatic hypotension in unselected hemodialysis patients.
Does not support predialysis verapamil for intradialytic BP control; confirms lack of benefit in unselected hemodialysis patients.
Decreased left ventricular compliance because of hypertrophy or fibrosis may contribute to hypotension during hemodialysis. While calcium channel blockade may reduce intradialytic hypotension in patients with left ventricular hypertrophy and refractory pulmonary congestion, it is unknown whether such an effect might be seen in unselected hemodialysis patients. Verapamil (40 mg) or a placebo was given 1 hour before hemodialysis to 10 patients in a double-blind crossover study. Two 2 week verapamil periods alternated with two 2 week placebo periods. Patients received bicarbonate for either 3 hours (7 patients, high-flux, Filtral, Gambro-Hospal Inc., Williamsburg, VA) or for 4 hours (3 patients, Travenol 15.11 or CA 110, Baxter Healthcare, Deerfield, IL). Left ventricular hypertrophy was present by ultrasound in 7 of 8 patients tested and by electrocardiogram in 1 of the remaining 2. Intradialytic blood pressures were similar during the drug and placebo trials. The number of episodes of symptomatic hypotension per hemodialysis was 0.99 with verapamil and 0.93 during the placebo periods (p less than 0.05). Thus, a single predialysis dosage of verapamil has no effect on intradialytic blood pressure in an unselected hemodialysis population.
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Sherman et al. (1990) conducted an RCT in Chronic hemodialysis (n=10). Verapamil vs. Placebo was evaluated on Episodes of symptomatic hypotension per hemodialysis (p=<0.05). A single 40 mg predialysis dose of verapamil had no effect on intradialytic blood pressure, with 0.99 episodes of symptomatic hypotension per session compared to 0.93 with placebo (p<0.05).
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