Why the study?
Does the addition of high-dose nifedipine cause pleural effusion and pulmonary edema in a patient with systemic hypertension?
Does the addition of high-dose nifedipine cause pleural effusion and pulmonary edema in a patient with systemic hypertension?
High-dose calcium channel blockers can induce severe pleural effusion and pulmonary edema, which resolves upon discontinuation of the offending agents.
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High-dose nifedipine may cause reversible pulmonary edema and pleural effusion; this case report leaves open causality and should not change practice.
Calcium channel blockers (CCBs) are very popular drugs to lower blood pressure (BP) without significant side effects. A 72-year-old man admitted for uncontrolled hypertension. He had history of hypertension, atrial fibrillation with slow ventricular response, angina, abdominal aortic aneurysm, and stage 3 chronic kidney disease. He had taken several anti-hypertensives, such as amlodipine 5 mg, perindopril 8 mg, and indepamide 1.5 mg. To control BP, nifedipine 120 mg was added. Then pulmonary edema and pleural effusion was developed. Echocardiography showed preserved left ventricular ejection fraction and mild mitral regurgitation. Fluid restriction and high dose furosemide did not cease pleural fluid accumulation. Thus a total of 4 times of thoracentesis were done and all fluid analyses revealed transudate. We thought that pleural effusion and pulmonary edema was induced by CCBs and discontinued the drugs. He recovered quickly and finally discharged in a stable condition.
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Kim et al. (2015) studied this question.
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