What is the role of calcium channel blockers (CCBs) in the treatment of idiopathic pulmonary arterial hypertension (IPAH)?

Updated: Jul 08, 2020
  • Author: Ronald J Oudiz, MD, FACP, FACC, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Until about 15 years ago, calcium channel blockers (CCBs) had been the most widely used class of drugs for IPAH. These drugs are thought to act on the vascular smooth muscle to dilate the pulmonary resistance vessels and lower the pulmonary artery pressure. Several studies report clinical and hemodynamic benefits from the use of long-term calcium channel blockade.

Only patients with an acute vasodilator response to an intravenous or inhaled pulmonary vasodilator challenge (eg, with inhaled nitric oxide at 10 to 20 parts per million, intravenous epoprostenol (2 to 12 ng/kg/min), intravenous adenosine (50 to 350 mg/min), or inhaled iloprost [5 mg]) derive any long-term benefit from CCBs. Such patients constitute less than 5% of patients with IPAH and probably less than 3% of patients with other forms of PAH. By consensus definition, a positive acute vasodilator response is defined by a decrease in mPAP 10 mm Hg or more to reach a mPAP less than 40 mm Hg. It should be noted that less than 50% of responders derive a long-term favorable response to CCBs, and thus close clinical monitoring of patients on CCBs for IPAH is required.

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