Common blood pressure meds linked to fatal side effects in some patients

A new evidence-based guideline for pulmonary arterial hypertension (PAH) cautions against the use of calcium channel blockers, a commonly used treatment for high blood pressure, in unstable patients due to the potentially fatal side effects associated with the medication.

PAH is a life-threatening condition that occurs when the arteries that supply blood to the lungs become constricted, limiting the blood flow to the lungs and, ultimately, causing high blood pressure to develop within the lung arteries.

The American College of Chest Physicians (ACCP) “Diagnosis and Management of Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines” provides recommendations for diagnosing and treating PAH.

Published in the July issue of CHEST, the peer-reviewed journal of the ACCP, the guideline was developed by a multidisciplinary panel of experts from five medical specialties and is endorsed by the American College of Cardiology Foundation, American College of Rheumatology, American Heart Association, and the Pulmonary Hypertension Association.

Panel members recommend against the use of calcium channel blockers or in patients who do not respond to acute pulmonary vasodilator testing, citing an increased risk of adverse and potentially fatal events related to the use of the medication. Due to the severity of the disease, the panel also advises genetic testing for patients with a family history of PAH and advance screening for patients with certain chronic diseases who are predisposed to PAH.

“Calcium channel blockers are regularly used to treat high blood pressure because they limit calcium entry into the cells and dilate the constricted systemic blood vessels, thereby lowering blood pressure... however, when they are used in patients with PAH whose narrowed pulmonary arteries are not caused by dynamic vessel constriction, the side effects can be fatal,” said Panel Chair Lewis J. Rubin, MD, FCCP, University of California San Diego School of Medicine, La Jolla, CA.

Moreover, he noted, patients in specific populations, such as women who are pregnant and patients with respiratory disease, are at greater risk of developing severe complications as a result of PAH.

Although the true incidence of PAH is unknown, it is estimated that more than 100,000 people in the United States suffer from PAH and several thousand new cases are diagnosed each year. Pulmonary hypertension can develop in patients of all ages and ethnic groups, and both genders; however, women ages 20 to 40 have the highest incidence of PAH.

SOURCE: "Diagnosis and Management of Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines,” CHEST, Volume 126/Number 1 Supplement, July, 2004.