Short- and long-term hemodynamic effects of oral nifedipine in patients with pulmonary hypertension secondary to COPD and lung fibrosis. Deleterious effects in patients with restrictive disease.

STUDY

OBJECTIVE

The present study was undertaken to evaluate at rest the short- and long-term effects of oral nifedipine (N) in patients with pulmonary hypertension (PH).

DESIGN AND

SETTING

A prospective study with ten consecutive cases during two years in a setting of a district acute hospital.

PATIENTS OR

PARTICIPANTS

Seven patients with advanced COPD and three with severe lung fibrosis (LF) during a period of stable condition. Three patients with COPD were eligible for the long-term investigation.

INTERVENTIONS: Right heart catheterization with a 7F Swan-Ganz triple-lumen thermodilution catheter and radial cannulation with a 3F arterial catheter.

MEASUREMENTS AND

RESULTS

Measurement of CO, MAP, RAP, PAP, PWP, HR, and ABG and calculation of CI, TSR, PAR, and DO2 before and after 20 mg of N sublingually at rest. For the group as a whole, N induced a reduction in MAP and TSR, with a significant increase in CI and DO2. There were no significant changes in PAP, PAR (magnitude of the reduction: -10 percent), HR, and PaO2. The individual analysis of the driving pressures (PAP-PWP) in function of the cardiac output demonstrated that a real vasodilating effect in the pulmonary circulation occurred in only three COPD patients (magnitude of the PAR reduction: -43 percent), while in the three patients with LF, N induced a deleterious increase in PAP and PAR. After long-term treatment (10 mg of N daily every 4 h; average 12 months) in the former, despite a persistent beneficial hemodynamic effect (magnitude of the PAR reduction: -36 percent), there was the usually expected clinical worsening.

CONCLUSIONS

N in small doses may be able in some patients with severe COPD to induce a beneficial short- and long-term hemodynamic effect on the pulmonary circulation when PH is present. On the other hand, N should not be used in patients with PH and advanced LF.