Medical therapy for pulmonary arterial hypertension

Driscoll, James A.; Chakinala, Murali M.

doi:10.1517/14656566.9.1.65

Cited by 10 publications

(4 citation statements)

References 105 publications

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“…PDE5 inhibitors are now widely used to treat pulmonary hypertension and erectile dysfunction (Croom et al, 2008; Driscoll et al, 2008; Rosen et al, 2003). More recently, PDE5 was implicated as an important regulator of cGMP in cardiac myocytes, including the hypertrophic response to pressure-overload stress (Borlaug et al, 2005; Nagayama et al, 2008; Takimoto et al, 2007; Takimoto et al, 2005a; Takimoto et al, 2005b; Zhang et al, 2008a), cell survival signaling and apoptosis associated with ischemia/reperfusion (Das et al, 2006), post-infarction remodeling (Salloum et al, 2008), and doxorubicin toxicity (Fisher et al, 2005).…”

Section: Cgmp Signalingmentioning

confidence: 99%

Cyclic GMP signaling in cardiovascular pathophysiology and therapeutics

Tsai

Kass

2009

Pharmacology & Therapeutics

356

330

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Cyclic guanosine 3′,5′-monophosphate (cGMP) mediates a wide spectrum of physiologic processes in multiple cell types within the cardiovascular system. Dysfunctional signaling at any step of the cascade---cGMP synthesis, effector activation, or catabolism---have been implicated in numerous cardiovascular diseases, ranging from hypertension to atherosclerosis to cardiac hypertrophy and heart failure. In this review, we outline each step of the cGMP signaling cascade and discuss its regulation and physiologic effects within the cardiovascular system. In addition, we illustrate how cGMP signaling becomes dysregulated in specific cardiovascular disease states. The ubiquitous role cGMP plays in cardiac physiology and pathophysiology presents great opportunities for pharmacologic modulation of the cGMP signal in the treatment of cardiovascular diseases. We detail the various therapeutic interventional strategies that have been developed or are in development, summarizing relevant preclinical and clinical studies.

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Section: Cgmp Signalingmentioning

confidence: 99%

Cyclic GMP signaling in cardiovascular pathophysiology and therapeutics

Tsai

Kass

2009

Pharmacology & Therapeutics

356

330

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“…28 Respiratory failure and PMV can occur as a complication of pulmonary hypertension (usually primary). The advances in treatment of pulmonary hypertension have resulted in improved survival in this population, 29 and in some cases allowed successful weaning from PMV. Diaphragm pacing has been used to liberate patients with spinal cord injury from PMV.…”

Section: Special Situationsmentioning

confidence: 99%

Long-Term Mechanical Ventilation: Management Strategies

White

2012

Respir Care

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SummaryThis paper reviews management strategies for patients undergoing prolonged mechanical ventilation (PMV). Topics covered include how to identify and correct barriers to weaning, the systematic approach to weaning trials, when to cease weaning trials and proceed with life-long support, managing the tracheostomy tube during PMV, and, finally, how to select a suitable mechanical ventilator for PMV.

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“…Indeed, it is now suggested that the combination of an endothelin receptor antagonist with a phosphodiesterase inhibitor is the preferred escalation of therapy for those with PAH who do not respond to single-therapy medication. [88,89] …”

Section: Combination Therapymentioning

confidence: 99%

Etiology, Diagnosis, and Pharmacologic Treatment of Pediatric Pulmonary Hypertension

Tulloh

2009

Pediatric Drugs

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Major advances have been made in the understanding and treatment of pulmonary hypertension in the last few years. Without treatment (medication) for idiopathic pulmonary arterial hypertension, which is a rare and potentially fatal condition, the survival time is only about 3 years after diagnosis. However, if pulmonary hypertension is secondary to other causes such as congenital heart disease, it is possible to survive for 30 years or more without treatment. The condition can affect children at any age, from fetal life to adulthood. Patients with pulmonary hypertension can present to the respiratory pediatrician with unresponsive asthma, to the neurologist with faints, or to the general pediatrician with failure to thrive. Over the last few years there have been significant developments in the available therapy for managing this complicated disease. There is now a generally recognized ladder of long-term therapy for chronic pulmonary hypertension. Treatment can start with oxygen at home at night or even during the day. Next is the use of oral phosphodiesterase inhibitors, mostly type V, such as sildenafil, which enhance endogenous nitric oxide. More potent are the endothelin receptor antagonists and the most potent are the prostanoids, especially epoprostenol, which is given by constant intravenous infusion. In addition to interventional catheterization with atrial septostomy, these agents have improved the prognostic outlook. This article reviews the current knowledge about the etiology, investigation, and treatment of children with pulmonary hypertension in the clinical setting.

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Medical therapy for pulmonary arterial hypertension

Cited by 10 publications

References 105 publications

Cyclic GMP signaling in cardiovascular pathophysiology and therapeutics

Cyclic GMP signaling in cardiovascular pathophysiology and therapeutics

Long-Term Mechanical Ventilation: Management Strategies

Etiology, Diagnosis, and Pharmacologic Treatment of Pediatric Pulmonary Hypertension

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