Treatment of pulmonary arterial hypertension (PAH): Updated Recommendations of the Cologne Consensus Conference 2011

Abstract

The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension have been adopted for Germany. The guidelines contain detailed recommendations on the diagnosis of pulmonary hypertension (PH). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the treatment of pulmonary arterial hypertension (PAH). This commentary describes in detail the results and recommendations of the working group on treatment of PAH which were last updated in October 2011.

Systemic sclerosis – diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part 2: treatment

“…Based on the results of clinical trials, the experts recommend endothelin ETA receptor antagonists (ambrisentan, bosentan and macitentan), PDE-5 inhibitors and riociguat in the treatment of pulmonary hypertension in patients with SSc. Clinical trials have found endothelin receptor inhibitors to significantly improve exercise capacity, survival and selected haemodynamic parameters in patients with PAH [15][16][17]. However, attention should also be given to adverse effects.…”

“…W badaniach klinicznych wykazano, że terapia antagonistami receptora endoteliny znaczą-co poprawiała wydolność wysiłkową, czas przeżycia i niektóre parametry hemodynamiczne u chorych z PAH [15][16][17]. Warto pamiętać o objawach niepożądanych, ponieważ oprócz działania hepatotoksycznego i teratogennego leki te mogą powodować obrzęki obwodowe, kołatania serca, ból głowy, Dermatology Review/Przegląd Dermatologiczny 2017/6 fil and tadalafil) also improve exercise capacity and prevent disease progression in patients with PAH [16,17]. Possible side effects associated with PDE-5 inhibitor therapy include facial flushing, dyspepsia, diarrhoea, headaches and myalgia.…”

“…Clinical trials involving patients with severe (class III or IV) PAH have shown intravenous epoprostenol to significantly reduce pulmonary vascular resistance and improve exercise capacity and haemodynamic parameters [19]. Similarly, other prostacyclin analogues (iloprost, treprostinil) are approved for and effective in the therapy of PAH associated with SSc [16,17]. Possible side effects to consider include headaches, mandibular pain, abdominal pain, arthralgia, diarrhoea, vomiting, anorexia, photosensitivity and cutaneous erythemas [17].…”

“…Possible side effects to consider include headaches, mandibular pain, abdominal pain, arthralgia, diarrhoea, vomiting, anorexia, photosensitivity and cutaneous erythemas [17]. The above mentioned medications are also contained in recommendations for the therapy of PAH [16,17,20]. Add-on therapies include diuretics, anticoagulants and oxygen therapy.…”

“…There have been no randomized ból w klatce piersiowej, obrzęk śluzówek nosa oraz niedokrwistość [17]. Wyniki badań klinicznych wykazały, że inhibitory PDE-5 (sildenafil i tadalafil) także poprawiają wydolność fizyczną i zapobiegają progresji choroby u pacjentów z PAH [16,17]. Podczas terapii może pojawić się napadowy rumień twarzy, dyspepsja, biegunka, bóle głowy i bóle mięśni.…”