METAANALYSIS OF THE LONG-TERM EFFECT OF NIFEDIPINE FOR PULMONARY-HYPERTENSION

Background: Pulmonary hypertensive disorders generally result in a pro gressively worsening course associated with substantial morbidity and mortality. Nifedipine therapy may provide an effective solution to att enuate the disease state. Objective: To assess the magnitude and consi stency of the effect of nifedipine on reducing pulmonary artery pressu re in patients with pulmonary hypertensive disorders. Design: A meta-a nalysis of 8 trials of nifedipine therapy. Methods: Clinical trials we re identified by a computerized literature search of MEDLINE and by an assessment of bibliographies of retrieved studies. Trials were select ed if they measured the change in pulmonary artery pressures in their subjects after weeks to months of therapy. Eight of 25 conducted trial s were selected for review. Results: Meta-analysis of 6 homogeneous tr ials demonstrated a significant decrease in pulmonary artery pressure: -7 mm Hg (95% confidence interval, -3 to -11 mm Hg; P<.01). Heterogen eity of trial results appeared to be due to differences in the severit y of initial pulmonary artery pressures and to differences in the dosa ge of nifedipine rather than the type of disease state. Conclusions: M eta-analysis of the trials of nifedipine therapy in patients with pulm onary hypertension demonstrated a decrease in pulmonary artery pressur e that was associated with an amelioration of clinical symptoms. Becau se of the paucity of data, however, larger trials are needed to better define its clinical value.