Manejo farmacológico da hipertensão arterial pulmonar

Abstract

Objective: To perform a review of the diagnostic and therapeutic management of pulmonary hypertension in the pediatric population, with emphasis on pharmacological factors.Sources: Electronic search of publications on the MEDLINE/PubMed, LILACS and Cochrane Collaboration databases. The search strategy adopted gave priority to the identification of clinical trials (controlled or uncontrolled), systematic reviews and directives published during the last 10 years.Summary of the findings: Many advances have been incorporated into our understanding of pulmonary hypertension during recent years. Issues related to differences in the pathophysiological mechanism of the disease between different age groups have altered both the treatment and prognosis of patients. The combined effect of more selective vasodilatory properties and antiproliferative action and the employment of new drugs are the basic principles of new treatment proposals. In order to be able to gauge the benefits associated with the use of these new therapies, it is of fundamental importance that all patients have their disease correctly diagnosed, the degree of functional compromise classified and their vascular reactivity capacity established, which is more difficult with pediatric patients. Conclusions:To date there is no treatment that can be considered ideal for the management of pulmonary hypertension. With reference to the possibility of employing new drugs, the majority of studies that have been published were undertaken with adult populations. Few data are available on children, and the majority of studies are uncontrolled trials or case series. Taking into account differences that have already been established between different age groups in terms of disease mechanisms and prognostic aspects, it is difficult to claim that these drugs can be incorporated into the treatment of childhood pulmonary hypertension with the same indications and results.J Pediatr (Rio J). 2006;82(5 Suppl):S153-65: Pulmonary arterial hypertension, pulmonary hypertension, nitric oxide, bosentan, sildenafil. REVIEW ARTICLE

Uso do sildenafil em paciente com hipertensão pulmonar: Um relato de caso

“…A associação de Sildenafil, como o proposto em bula, causou suposta redução da pressão pulmonar, com controle dos sintomas, redução da dependência do suporte de O2, melhora do padrão hemodinâmico e da capacidade funcional (Machado, 2008;Freitas Júnior et al, 2009) Vale ainda pontuar o uso da Anlodipina como coadjuvante da terapêutica da hipertensão pulmonar, utilizado pela paciente também no controle pressórico arterial sistêmica, uma vez que os antagonistas dos canais promovem a vasodilatação pulmonar (Oliveira & Amaral, 2005). Embora a aplicação de vasodilatadores congestivos e betabloqueadores sejam contra indicadas em pacientes com hipertensão pulmonar, a paciente faz uso de um betabloqueador de terceira geração, pois não causam os efeitos adversos típicos dos betabloqueadores de primeira e segunda geração (broncoespasmo, bradicardia e vasodilatação periférica), podendo ser usados na paciente em questão (Barreto & Gazzana, 2000;Ricachinevsky & Amantéa, 2006).…”