Current Therapy of Pulmonary Hypertension

Abstract

Pulmonary arterial hypertension (PAH) affects vascular proliferation and remodeling in small pulmonary arteries and results in right ventricular failure and death due to a progressive increase in pulmonary vascular resistance. Recent advances in understanding of the molecular mechanisms involved in PAH suggest that endothelial dysfunction plays a major role. Impaired production of vasoactive mediators, such as prostacyclin and nitric oxide, accompanied with prolonged overexpression of vasoconstrictors such as endothelin-1, affects vascular tone and reinforces vascular remodeling. As the latter substances represent logical pharmacological targets, new drugs affecting these mechanisms have evolved during the past 2 decades and led to umpteen placebo-controlled trials in bygone years. Prognosis and quality of life of patients suffering from PAH seem to improve due to these new treatment strategies resulting in a reduction of mortality and morbidity, but there is still a substantial need for further long-term and head-to-head trials.

Diagnosis and Assessment of Pulmonary Arterial Hypertension

“…It is difficult to assess the inotropic properties of prostanoids because of the strong vasodilative effects of these substances. Epoprostenol has a positive inotropic effect on the RV (150), but this may be caused by baroreflex activation. In isolated cardiomyocytes, treprostinil per se had no positive inotropic effects, but it significantly amplified the positive inotropic effects of catecholamines (151).…”

Neue Aspekte zur Diagnostik und Therapie der akuten und chronischen pulmonalen Hypertonie

“…Die derzeitige Therapie der pulmonalen Hypertonie wird von Baumhäkel et al mit dem Ausblick auf zukünftige Therapieverfahren dargestellt [16]. Die Überlebensrate von Patienten mit primärer pulmonaler Hypertonie, die mit hochdosierten Dosen von Calciumantagonisten behandelt wurden, ist exzellent [18].…”