Pulmonary Vasodilators—Treating the Right Ventricle

Granton, John; Moric, Jakov

doi:10.1016/j.anclin.2008.01.010

Cited by 26 publications

(21 citation statements)

References 88 publications

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“…The primary function of NO is the regulation of vascular tone, inhibition of VSMC proliferation and platelet aggregation (45). Also it has long been believed that one factor in the progression of PAH is an imbalance between the vasodilation and vasoconstriction of the pulmonary circulation (46). This is most likely due to a decrease in the amount of available NO and prostacyclin, accompanied by an increase in production of vasoconstrictors such as endothelin and thromboxanes (46).…”

Section: Nitric Oxide Pathway and Pahmentioning

confidence: 99%

“…Also it has long been believed that one factor in the progression of PAH is an imbalance between the vasodilation and vasoconstriction of the pulmonary circulation (46). This is most likely due to a decrease in the amount of available NO and prostacyclin, accompanied by an increase in production of vasoconstrictors such as endothelin and thromboxanes (46). Indeed lower levels of NO and higher levels of thromboxanes (A 2 specifically) have been reported in PAH patients compared to controls (6).…”

Section: Nitric Oxide Pathway and Pahmentioning

confidence: 99%

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Nitric oxide, oxidative stress and inflammation in pulmonary arterial hypertension

Crosswhite

Sun

2010

Journal of Hypertension

153

137

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Pulmonary arterial hypertension (PAH) is a chronic and progressive disease characterized by a persistent elevation of pulmonary artery pressure accompanied by right ventricular hypertrophy (RVH). The current treatment for pulmonary hypertension is limited and only provides symptomatic relief due to unknown etiology and pathogenesis of the disease. Both vasoconstriction and structural remodeling (enhanced proliferation of VSMC) of the pulmonary arteries contribute to the progressive course of PAH, irrespective of different underlying causes. The exact molecular mechanism of PAH, however, is not fully understood. The purpose of this review is to provide recent advances in the mechanistic investigation of PAH. Specifically, this review focuses on nitric oxide (NO), oxidative stress and inflammation and how these factors contribute to the development and progression of PAH. This review also discusses recent and potential therapeutic advancements for the treatment of PAH.

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Section: Nitric Oxide Pathway and Pahmentioning

confidence: 99%

Section: Nitric Oxide Pathway and Pahmentioning

confidence: 99%

Nitric oxide, oxidative stress and inflammation in pulmonary arterial hypertension

Crosswhite

Sun

2010

Journal of Hypertension

153

137

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“…6 As remodeling of the pulmonary vascular bed progresses, PVR rises, increasing right ventricular afterload and leading to decreased functional capacity and eventually right ventricular failure. 7 The diagnosis and treatment of PAH is hampered by difficulty in obtaining accurate measurements of PAP. Unlike the systemic circulation where intravascular pressure is easily measured by syphgmometry, there is no accurate, readily available noninvasive test for measuring PAP.…”

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

Brain natriuretic peptide in pulmonary arterial hypertension: biomarker and potential therapeutic agent

Casserly

Klinger²

2009

DDDT

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B-type natriuretic peptide (BNP) is a member of the natriuretic peptide family, a group of widely distributed, but evolutionarily conserved, polypeptide mediators that exert myriad cardiovascular effects. BNP is a potent vasodilator with mitogenic, hypertrophic and pro-inflammatory properties that is upregulated in pulmonary hypertensive diseases. Circulating levels of BNP correlate with mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with pulmonary arterial hypertension (PAH). Elevated plasma BNP levels are associated with increased mortality in patients with PAH and a fall in BNP levels after therapy is associated with improved survival. These findings have important clinical implications in that a noninvasive blood test may be used to identify PAH patients at high-risk of decompensation and to guide pulmonary vasodilator therapy. BNP also has several biologic effects that could be beneficial to patients with PAH. However, lack of a convenient method for achieving sustained increases in circulating BNP levels has impeded the development of BNP as a therapy for treating pulmonary hypertension. New technologies that allow transdermal or oral administration of the natriuretic peptides have the potential to greatly accelerate research into therapeutic use of BNP for cor pulmonale and pulmonary vascular diseases. This review will examine the basic science and clinical research that has led to our understanding of the role of BNP in cardiovascular physiology, its use as a biomarker of right ventricular function and its therapeutic potential for managing patients with pulmonary vascular disease.

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“…If the situation remains refractory it is worth considering nitric oxide (NO) to selectively treat right ventricular pressure overload. There is to our knowledge no published work on the use NO in DHF but it remains as an option if all else fails (Granton & Moric, 2008;Natori etal, 2003).…”

Section: Additional Management Considerationsmentioning

confidence: 99%