Verapamil increases serum alkaline phosphatase in hypertensive patients

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Abstract
In rats, verapamil decreases intestinal absorption of calcium, increases serum parathyroid hormone (PTH), and induces osteopenia. In this prospective study, verapamil 80-120 mg three times daily was given for 2 months to 20 patients with hypertension, and the effects on calcium homeostasis were recorded. This dose of verapamil significantly reduced supine systolic and diastolic blood pressure (.+-. SD) from 158/100 .+-. 9/8 mmHg to 146/89 .+-. 14/8 mmHg (P = 0.001). Serum alkaline phosphatase (ALP) increased significantly from 2.77 .+-. 1.06 .mu.kat l-1 to 3.19 .+-. 1.22 .mu.kat l-1 (P = 0.004), and isoenzymes of ALP of skeletal origin appeared after verapamil treatment. The excretion of sodium in the urine increased (Na/creatinine ratio 8.95 .+-. 6.01 before and 13.16 .+-. 8.26 after verapamil; P = 0.04), while the excretion of calcium, phosphate and potassium was not changed. PTH was slightly increased at the end of verapamil treatment (1.09 .+-. 0.54 vs. 0.98 .+-. 0.74 .mu.g l-1; P = 0.07), and s-1,25(OH)3D3 was also somewhat increased (22.3 .+-. 14.4 vs. 17.6 .+-. 4.9 ng l-1; P = 0.26). Serum Ca was not affected by verapamil (before verapamil 2.43 .+-. 0.11 mmol l-1, after verapamil 2.40 .+-. 0.12 mmol l-1; P =0.28). The increase in serum ALP demonstrates that verapamil affects bone cell metabolism in man. This effect could be secondary to the enhancement of PTH secretion.

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