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Pulmonary Arterial Hypertension: New Management Options.
MedLine Citation:
PMID:  15496262     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
The past decade has realized remarkable advances in the treatment of pulmonary arterial hypertension (PAH), a progressive and potentially fatal disease. A small proportion of patients will have a dramatic hemodynamic response to acute vasodilator testing performed at the time of right heart catheterization and may be candidates for calcium channel blocker therapy. The vast majority of patients with PAH will not benefit from calcium channel blockers and should be treated with one of the three US Food and Drug Administration-approved therapies for PAH; bosentan, treprostinil, or epoprostenol. Because of the ease of administration relative to other therapies, the majority of patients with functional class III symptoms should be treated with the oral nonselective endothelin antagonist bosentan. Randomized controlled trials with treprostinil have demonstrated improvements in exercise endurance and hemodynamics. Patients who are critically ill, with functional class IV symptoms, should be started on epoprostenol because it is the most rapidly effective therapy. Intravenous epoprostenol improves exercise endurance, quality of life, hemodynamics, and survival in PAH. Investigational therapies on the horizon include phosphodiesterase inhibitors, prostacyclin analogues with alternative delivery routes (eg, inhaled, oral), and selective endothelin A receptor antagonists. The future of PAH therapy will likely include combinations of these therapies based on the multiple mechanisms of action.
Authors:
Mark D Huffman; Vallerie V McLaughlin
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  6     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2004 12 
Date Detail:
Created Date:  2004-10-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  451-458     Citation Subset:  -    
Affiliation:
University of Michigan Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, 1500 East Medical Center Drive, L3119 Women’s Hospital, Ann Arbor, MI 48109-0273, USA. vmclaugh@umich.edu.
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