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September 6, 1985

Nifedipine-Induced Hypotension and Myocardial Ischemia in Refractory Angina Pectoris-Reply

Author Affiliations

Brown University Miriam Hospital Providence, RI

JAMA. 1985;254(9):1175. doi:10.1001/jama.1985.03360090065018

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In Reply.—  We thank Dr Sachs for his critical comments regarding our recent publication and would like to clarify some of the issues he raises. Our clinical report was based on the retrospective observation that ten patients regularly complained of angina pectoris within minutes of their usual dose of nifedipine. This prompted us to verify prospectively their complaints by ascertaining both subjective and objective indices of myocardial ischemia when patients were administered their routine dose of nifedipine as prescribed and titrated by each patient's private physician. Furthermore, the 80-mg dose of nifedipine cited in our article was the lowest dose that was still observed to produce subjective and objective findings of paradoxical myocardial ischemia within this patient group.It was never our intent to elucidate the pathophysiologic basis of paradoxical myocardial ischemia in these patients. As we clearly stated, such an analysis would have required quantitative measurements of coronary blood