Death in a Patient with Primary Pulmonary Hypertension after 20 mg of Nifedipine

To the Editor: A favorable long-term effect of large doses of nifedipine or diltiazem has been reported in patients with primary pulmonary hypertension when the therapy was guided by invasive testing¹. We had an unfortunate experience after such testing. A 17-year-old previously healthy woman had dyspnea and fatigue for nine months. A diagnosis of primary pulmonary hypertension with right heart failure was made. The pulmonary-artery pressure was 95/52 mm Hg, the wedge pressure 17 mm Hg, and the cardiac output 1.8 liters per minute. Therapy consisted of warfarin, furosemide, and spironolactone. Single-lung transplantation was considered necessary. Three weeks later,…