Impact of Nebulized Verapamil in Patients with Pulmonary Hypertension Secondary to Lung Diseases

Background: Pulmonary hypertension (PH) secondary to chronic lung diseases (CLD) remains a major therapeutic challenge, as systemic vasodilators may aggravate ventilation–perfusion mismatch and worsen hypoxemia. Inhaled therapy offers the potential for selective pulmonary vasodilation with minimal systemic effects.Aim: To evaluate the efficacy and safety of nebulized verapamil on respiratory, hemodynamic, and functional parameters in patients with group 3 PH due to CLD.Patients and Methods: A double-blind, randomized, placebo-controlled trial was conducted on 45 patients with PH secondary to CLD, divided equally into three groups: control (placebo), verapamil 10 mg, and verapamil 20 mg. Nebulized verapamil or placebo was administered twice daily for three days. The primary outcome was the change in oxygenation (SpO₂) and RVSP following treatment.Results: All study groups demonstrated significant improvements over time in SpO₂ (time effect p < 0.001), with no significant difference between the verapamil and placebo groups (time × treatment interaction p = 0.883). Verapamil treatment was associated with significant reductions in systolic blood pressure (−16 mmHg with 10 mg and −10 mmHg with 20 mg; interaction p < 0.001) and improvements in pulmonary function parameters (FVC and FEV₁), which were not observed in the control group. Right ventricular systolic pressure decreased significantly in both verapamil groups. Bradycardia occurred only in the 20 mg group (20%).Conclusion: Nebulized verapamil produced short-term improvements in pulmonary hemodynamics and lung function without impairing oxygenation; the 10 mg dose showed the most favorable efficacy–safety profile, supporting its use as an acute adjunct therapy.