The Effect of High Doses of Calcium-Channel Blockers on Survival in Primary Pulmonary Hypertension

Rich, Stuart; Kaufmann, Elizabeth; Levy, Paul S.

doi:10.1056/nejm199207093270203

Cited by 1,415 publications

(926 citation statements)

References 20 publications

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“…30 In another small prospective study, Rich et al showed that patients who did not respond to calcium channel blockers and who were treated with anticoagulants had improved survival as compared with those who were not anticoagulated. 31 …”

Section: Pharmacologic Treatment Anticoagulantsmentioning

confidence: 99%

“…A decrease of at least 20% in PAP from the baseline value and a decrease of >30% in PVR with an increased or unchanged cardiac output is usually predictive of a favourable response. [31][32][33][34][35] Some workers accept a decrease in mean PAP by >10 mmHg, to a value <40 mmHg with no reduction in cardiac output. 36 Generally only 10-15% of iPAH patients show a positive acute vasoreactive response and about half of them will continue to respond to calcium channel blockers over a long period of time.…”

Section: Vasodilator Challengementioning

confidence: 99%

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Pulmonary hypertension—“state of the art” management in 2012

Saxena

2012

Indian Heart Journal

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A B S T R A C TPulmonary artery hypertension (PAH) is a pathological condition of small pulmonary arteries, characterised by vascular proliferation and remodelling. The pulmonary artery pressure and pulmonary vascular resistance progressively rise, leading to right heart failure and death. Pulmonary artery hypertension may be secondary to various conditions, or it may be idiopathic where no underlying cause is identifiable. Earlier, only symptomatic treatment was available for such patients which did not change the natural history of the disease. However, over the years, improvement in understanding the pathogenesis has resulted in the development of targeted approaches to the treatment of PAH. Survival advantage has also been shown with some of the pharmacologic agents. This review article discusses the current management strategy for PAH with special emphasis on an idiopathic variety, in an Indian context.

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Section: Pharmacologic Treatment Anticoagulantsmentioning

confidence: 99%

Section: Vasodilator Challengementioning

confidence: 99%

Pulmonary hypertension—“state of the art” management in 2012

Saxena

2012

Indian Heart Journal

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“…Two small retrospective studies (45,46) reported improved survival with oral anticoagulation in patients with idiopathic PAH. On the basis of these reports and the knowledge that microscopic in situ thrombosis can occur, anticoagulation with warfarin is recommended.…”

Section: General Measuresmentioning

confidence: 99%

“…Patients with idiopathic PAH who respond to vasodilators in the short term have improved survival with longterm use of calcium-channel blockers (46,49). Various short-acting agents, including intravenous epoprostenol or adenosine and inhaled nitric oxide, have been used to test short-term response to vasodilators (50,51).…”

Section: Vasodilator Testing and Calcium-channel Blockersmentioning

confidence: 99%

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Rubin

Badesch²

2005

Ann Intern Med

126

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Increased pressure in the pulmonary circulation, or pulmonary hypertension, is a common disorder that may complicate various cardiopulmonary conditions, including severe obstructive airways disease and left ventricular dysfunction. An increase in pulmonary arterial pressure that is not due to coexistent cardiopulmonary disease, known as pulmonary arterial hypertension, may occur in the absence of a demonstrable cause (idiopathic or familial); as a complication of systemic conditions, such as connective tissue disease, HIV infection, or chronic liver disease; or as a result of the use of fenfluramine anorexigens, amphetamines, or cocaine. The development of disease-specific therapies for pulmonary arterial hypertension over the past decade underscores the importance of diagnosing pulmonary hypertension early in the course of the condition and implementing a treatment strategy that is based on the condition's cause and severity. In this review, the authors present approaches to the diagnosis and management of pulmonary arterial hypertension, using a hypothetical case to highlight the key management points. U ntil recently, management of pulmonary arterial hypertension (PAH) was generally ineffective in alleviating symptoms or improving survival. However, the past decade has witnessed remarkable advances in our understanding of the pathogenesis of PAH, advances that have led to the development of disease-specific treatments. Despite these achievements, PAH remains a challenging condition to diagnose and manage. This article reviews recent developments in the diagnosis and management of PAH in the context of a typical case, illustrating the importance of collaboration between the internist and the specialist in patient care.

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“…Therapy with high oral doses of calcium-channel blocking agents has been shown to be effective in a selected group of patients (27,28). It has also been shown that continuous intravenous infusion of prostacyclin is beneficial (29)(30)(31)(32)(33).…”

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confidence: 99%

Long‐term iloprost infusion therapy for severe pulmonary hypertension in patients with connective tissue diseases

Mata

Gómez-Sánchez

Aranzana

et al. 1994

Arthritis & Rheumatism

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Objective. To determine the effects of short-term, maximum-tolerated-dose and long-term, optimum-dose iloprost treatment of severe pulmonary hypertension associated with systemic sclerosis (SSc) and the primary antiphospholipid syndrome (APS).Methods. Three patients with SSc and 2 with APS who had failed to respond to oral vasodilator therapy for pulmonary hypertension were enrolled in a 32-week, open, prospective trial. Short-term infusion of maximumtolerated doses and continuous infusion of optimum doses of iloprost were carried out following baseline cardiac catheterization. Catheterization was repeated at 2 and 32 weeks. All 5 patients completed the study and continued therapy for an average of 82 weeks (range 58-103).Results. Acute infusion of maximum tolerated doses significantly ameliorated the cardiac index (0.92 liters/minute/m2; P < O.OI), pulmonary artery 0, saturation (10.6%; P < 0.05), and pulmonary resistance (-6.7 units; P < 0.05). After 2 weeks of continuous infusion of optimum doses, there was improvement in pulmonary resistance (216%) and pulmonary artery 0, saturation (>30%) in the 2 patients with primary APS.

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The Effect of High Doses of Calcium-Channel Blockers on Survival in Primary Pulmonary Hypertension

Abstract: This study suggests that high doses of calcium-channel blockers in patients with primary pulmonary hypertension who respond with reductions in pulmonary-artery pressure and pulmonary vascular resistance may improve survival over a five-year period.

Cited by 1,415 publications

References 20 publications

Pulmonary hypertension—“state of the art” management in 2012

Pulmonary hypertension—“state of the art” management in 2012

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Long‐term iloprost infusion therapy for severe pulmonary hypertension in patients with connective tissue diseases

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