High-Dose Calcium Channel Blockade in PH: Old Lessons, New Tools

This letter to the editor revisits the origins of high-dose calcium channel blocker use in pulmonary arterial hypertension (PAH) in light of bedside vasoreactivity testing, reaffirming its present-day relevance for a selected subgroup. Integrating historical insights with modern tools, the authors highlight: the “responder” phenotype as an expression of precision medicine; ion channels as pathobiological targets; the value of real-world registries and benchmarks for high-quality care pathways; attention to special contexts (interstitial lung disease in connective-tissue diseases, and sex differences in diastolic dysfunction/HFpEF). In sum, we propose a personalized approach that pairs careful high-dose titration in appropriate candidates with molecular phenotyping and standardized follow-up.