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March 24, 1997

Meta-analysis of the Long-term Effect of Nifedipine for Pulmonary Hypertension

Author Affiliations

From the Division of Pulmonary and Critical Care Medicine (Drs Malik and Lehrman) and Section of General Internal Medicine (Dr Warshafsky), Department of Medicine, New York Medical College, Valhalla.

Arch Intern Med. 1997;157(6):621-625. doi:10.1001/archinte.1997.00440270057005

Background:  Pulmonary hypertensive disorders generally result in a progressively worsening course associated with substantial morbidity and mortality. Nifedipine therapy may provide an effective solution to attenuate the disease state.

Objective:  To assess the magnitude and consistency of the effect of nifedipine on reducing pulmonary artery pressure in patients with pulmonary hypertensive disorders.

Design:  A meta-analysis of 8 trials of nifedipine therapy.

Methods:  Clinical trials were identified by a computerized literature search of MEDLINE and by an assessment of bibliographies of retrieved studies. Trials were selected if they measured the change in pulmonary artery pressures in their subjects after weeks to months of therapy. Eight of 25 conducted trials were selected for review.

Results:  Meta-analysis of 6 homogeneous trials demonstrated a significant decrease in pulmonary artery pressure: —7 mm Hg (95% confidence interval, —3 to —11 mm Hg; P<.01). Heterogeneity of trial results appeared to be due to differences in the severity of initial pulmonary artery pressures and to differences in the dosage of nifedipine rather than the type of disease state.

Conclusions:  Meta-analysis of the trials of nifedipine therapy in patients with pulmonary hypertension demonstrated a decrease in pulmonary artery pressure that was associated with an amelioration of clinical symptoms. Because of the paucity of data, however, larger trials are needed to better define its clinical value.Arch Intern Med. 1997;157:621-625