High dose titration of calcium channel blocking agents for primary pulmonary hypertension: Guidelines for short-term drug testing

Stuart Rich*, Elizabeth Kaufmann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

Forty-seven patients with primary pulmonary hypertension were evaluated with a dose titration protocol utilizing nifedipine (20 mg orally) or diltiazem (60 mg orally) given every hour until maximal effectiveness was achieved. Of the patients tested, 15 (32%) had a >20% reduction in pulmonary artery pressure (mean 36.2 ± 8%, p < 0.01) and pulmonary vascular resistance (mean 50.2 ± 7%, p < 0.01) (pressure responders). Nineteen (40%) had 4.2 ± 20% reduction in pulmonary vascular resistance (mean 25.2 ± 12%, p < 0.01), with less than a 20% decrease in pulmonary artery pressure (resistance responders). Ten had no significant change in pulmonary artery pressure or pulmonary vascular resistance (nonresponders), and three were unable to tolerate the calcium channel blocking agents. No hemodynamic profile allowed prediction of the type of response to these agents. No mortality or serious morbidity was associated with the drug testing. These findings indicate that calcium channel blockers when titrated to maximally effective doses, may cause substantial reductions in pulmonary artery pressure and pulmonary vascular resistance in patients with primary pulmonary hypertension. Testing with hemodynamic monitoring is necessary to ascertain which patients will respond. Patients with primary pulmonary hypertension are able to tolerate short-term administration of high doses of calcium channel blockers.

Original languageEnglish (US)
Pages (from-to)1323-1327
Number of pages5
JournalJournal of the American College of Cardiology
Volume18
Issue number5
DOIs
StatePublished - Nov 1 1991

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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