“…Previously, Ghofrani et al 7 demonstrated that riociguat, through the direct activation of GCs, promoted an increase in cyclic GMP and consequently pulmonary vasodilation, and its administration 3 times daily in patients with PAH improved serum N terminal pro B type natriuretic peptide (NT-proBNP) concentrations, time to clinical worsening, and WHO functional class. 7 Reduction of NT-proBNP levels was not observed by Spilimbergo et al, 6 possibly explained by the small number of patients included in the study. Similarly, in 2015, the CHEST-2 study described that long-term administration of riociguat in patients with CTEPH improved exercise and functional capacity.…”