From the Guidelines
Verapamil should be avoided in patients with significant aortic regurgitation due to its potential to worsen the condition by increasing regurgitant volume and compromising cardiac function. As a calcium channel blocker, verapamil reduces peripheral vascular resistance and causes vasodilation, which can exacerbate the hemodynamic effects of aortic regurgitation 1. In aortic regurgitation, blood flows backward into the left ventricle during diastole, creating volume overload. Verapamil's vasodilatory effects can increase this regurgitant volume by reducing afterload, potentially worsening the condition and increasing cardiac workload.
Some key points to consider in the management of aortic regurgitation include:
- The aims of medical management are to control systemic hypertension, reduce regurgitant volume, and minimize adverse remodelling 1.
- Calcium channel antagonists, such as nifedipine, have been shown to reduce or delay the need for surgery in asymptomatic patients with aortic regurgitation, but their impact on survival remains unclear 1.
- ACE inhibitors or angiotensin receptor blockers are generally preferred for blood pressure management in patients with aortic regurgitation, as they provide afterload reduction without negative inotropic effects.
- Beta-blockers may have a role in selected patients with aortic regurgitation, particularly those with Marfan’s syndrome or comorbid conditions, but their use should be individualized based on the patient's specific clinical picture 1.
In patients with aortic regurgitation requiring blood pressure management, it is essential to choose medications that do not exacerbate the condition. ACE inhibitors or angiotensin receptor blockers are generally the preferred agents, as they can help reduce regurgitant volume and minimize adverse remodelling without compromising cardiac function 1. If a patient with aortic regurgitation is currently taking verapamil, they should consult their cardiologist about potentially switching to a more appropriate medication based on their specific cardiac status and overall clinical picture.
From the Research
Effects of Verapamil on Aortic Regurgitation
- Verapamil, a calcium channel blocker, has been studied for its effects on aortic regurgitation in several clinical trials 2, 3, 4, 5, 6.
- A study published in the American Heart Journal in 1985 found that verapamil resulted in a 24% decrease in regurgitant fraction in patients with aortic insufficiency, suggesting that verapamil may be beneficial in reducing aortic regurgitation 2.
- The study also found that verapamil increased cardiac index and forward stroke volume index, while decreasing left ventricular end-systolic stress, indicating improved hemodynamic function 2.
- Another study published in the Journal of Vascular Surgery in 1989 found that verapamil reduced postoperative heart rate and pressure-rate product in patients undergoing abdominal aortic reconstruction, which may also suggest a beneficial effect on aortic regurgitation 4.
- However, the other studies reviewed did not specifically investigate the effects of verapamil on aortic regurgitation, but rather focused on its use in hypertension, coronary artery disease, and Marfan syndrome 3, 5, 6.
- Overall, the available evidence suggests that verapamil may not worsen aortic regurgitation and may even have beneficial effects on hemodynamic function in patients with aortic insufficiency 2.