To the Editor.—Jaker and coworkers1 have confirmed earlier studies showing that a single 10-mg dose of oral nifedipine is effective and safe for the treatment of hypertensive urgency. However, there are recent reports of complications related to this treatment: cerebral ischemia2 or retinal ischemia3 occurring in the absence of hypotension, severe hypotension following repeated doses given over a short time interval, 4 and hypotension following a single oral dose of nifedipine.5 While these complications represent the exception to the currently safe use of nifedipine, caution is recommended in the treatment of hypertensive urgency, particularly in the elderly and those with coronary or cerebrovascular disease.1 We present the case of a young hypertensive man with no history of cerebrovascular disease, who had, on two occasions, ischemic strokes coincident with the use of a single 10-mg capsule of nifedipine.
Report of a Case.—A 44-year-old white
SCHWARTZ M, NASCHITZ JE, YESHURUN D, SHARF B. Oral Nifedipine in the Treatment of Hypertensive Urgency: Cerebrovascular Accident Following a Single Dose. Arch Intern Med. 1990;150(3):686–687. doi:10.1001/archinte.1990.00390150152031