Pulmonary Arterial Hypertension: Current Therapies
Greater understanding of the etiology and pathophysiology of pulmonary arterial hypertension has led to significant advances in therapy for this disease. In addition, the publication of the American College of Chest Physicians’ (ACCP’s) evidence-based treatment guidelines in Chest in 2004 has aided physicians somewhat in treatment decisions. Nevertheless, treatment remains very complicated because patients respond differently to available therapies. Treatment protocols are generally tailored to suit the individual and are devised in pulmonary hypertension (pulmonary hypertension) specialist centers. As mentioned previously, pulmonary arterial hypertension is one class of conditions under pulmonary hypertension. Table 3 summarizes the therapies currently used for pulmonary arterial hypertension. The major drug classes used in the treatment of pulmonary arterial hypertension are vasodilators, such as the prostacyclin analogues (e.g., epoprostenol sodium [GlaxoSmifhKline's Flolan]); endothelin-receptor antagonists (ERAs); calcium-channel blockers (CCBs); vitamin K antagonists; diuretics; and cardiac glycosides. The aim of pharmacotherapy is to reduce pulmonary vascular resistance, temper pulmonary vascular remodeling, prevent thrombus formation, reduce volume overload, and maintain cardiac output. A series of lifestyle modifications — most importantly reduced physical activity — is often recommended in addition to drug therapy. In the more advanced stages of disease, patients may become candidates for surgical interventions, including lung transplantation.
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