Nifedipine in chronic cor pulmonale: acute and relatively long-term effects

Abstract

After 20 mg sublingual nifedipine in 12 men with clinical stable chronic cor pulmonale the mean arterial pressure and systemic vascular resistance fell, cardiac index rose, and mean pulmonary arterial (Ppa) and wedge (Ppaw) pressures, right atrial pressure, and PaO2 remained unchanged. After 20 mg orally every 6 hours for 24 hours in 11 patients, the mean arterial pressure fell further, systemic vascular resistance remained low, and the cardiac index returned to baseline, whereas the Ppa and Ppaw decreased, but the pulmonary vascular driving pressure (Ppa-Ppaw), right atrial pressure, PaO2, and spirometry and ejection fractions remained unchanged. Of eight patients receiving maintenance therapy four developed untoward side effects in 1 to 3 weeks and one was noncompliant. The remaining three patients evaluated at 6 weeks failed to improve and had unchanged resting hemodynamics. Thus in the absence of a potentially reversible hypoxic pulmonary hypertension, nifedipine may not improve pulmonary arterial pressure and cardiac function in clinically stable patients with cor pulmonale.

Right atrial function in hypertensive patients: effects of antihypertensive therapy

“…27 Furthermore, calcium channels blockers but not angiotensin-converting enzyme inhibitors, cause deterioration in pulmonary gas exchange. 28 An interesting finding of this study is the effects of left ventricular mass and RV-IVRT on the changes of RA performance induced by antihypertensive treatment as well as the significant interaction between these covariates and the treatment effect. This modification is an additional support of diastolic ventricular interaction, as changes in left ventricular mass and RV relaxation affect atrial active contribution.…”

Pulmonary Hypertension and Right Heart Dysfunction in Chronic Lung Disease

“…Their use has been debatable due to reports of worsening V/Q mismatch [114, 115], lack of long-term effectiveness through the development of tolerance [116, 117], and the high incidence of side effects including ankle oedema, headache, and facial flushing [117]. In our earlier study felodipine, a nonselective dihydropyridine calcium channel blocker, significantly improved pulmonary haemodynamics in patients with COPD and PH [118].…”

Pulmonary Hypertension in Chronic Lung Diseases and/or Hypoxia

“…Reports of worsening ventilation / perfusion (V/Q) inequality [70,71], a lack of long-term effectiveness (or development of tolerance) [72,73] and the high incidence of side effects [73] have raised doubts about the benefits of a non-selective vasodilator treatment in COPD.…”