A case of primary pulmonary hypertension associated with carotid sinus hypersensitivity

A case of primary pulmonary hypertension (PPH) associated with carotid sinus hypersensitivity is described. The patient, a 58-year-old Japanese man with a recent history of frequent episodes of syncope. After physical examination and cardiac catheterization, he was diagnosed as having PPH. Carotid sinus massage was followed by a profound decrease in systolic blood pressure. A beneficial effect on pulmonary hypertension was attained with sublingual nifedipine and intravenous prostaglandin E1. Thereafter, treatment was continued with nifedipine (20 mg/day p.o.) and limaprost (30 ug/day p.o.). Following three months of the medication, pulmonary hypertension was alleviated and nifedipine continued to be effective, but limaprost was not effective in reducing pulmonary hypertension. It was noted that once the pulmonary hypertension had decreased, carotid sinus massage did not induce further decrease of systolic blood pressure. No episode of syncope developed while the patient was under the vasodilator therapy.