title: 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.
abstract: 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).
  
  
  METHODS
  A prospective study with ten consecutive cases during two years in a setting of a district acute hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Right heart catheterization with a 7F Swan-Ganz triple-lumen thermodilution catheter and radial cannulation with a 3F arterial catheter.
  
  
  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.
authors.affiliation: Dipartimento di Medicina Interna dell' Ospedale Distrettuale La Carità di Locarno, Switzerland.
authors.forename: G M
authors.initials: GM
authors.lastname: Domenighetti
authors.forename: V G
authors.initials: VG
authors.lastname: Saglini
mesh_terms: D000368:Aged; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D008173:Lung Diseases, Obstructive / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000187:drug effects*; D011658:Pulmonary Fibrosis / Q000150:complications* / Q000188:drug therapy
chemical_list: D009543:Nifedipine