Recognition and management of pulmonary hypertension

摘要: Pulmonary hypertension (mean pulmonary arterial pressure > 20mm Hg at rest or 30mm during exercise) occurs (i) as primary (no known underlying cause), (ii) persistent of the newborn (iii) secondary to a variety lung and cardiovascular diseases. In last 10 15 years there have been significant advances in medical management this debilitating life-threatening disorder. The main drugs current use are anticoagulants (warfarin, heparin) vasodilators, especially oral calcium antagonists, intravenous prostacyclin (prostaglandin I2; epoprostenol) inhaled nitric oxide. Calcium (e.g. nifedipine, diltiazem) used chiefly hypertension. They effective patients who give vasodilator response an acute challenge with short acting prostacyclin, oxide adenosine), doses greater than usual treatment other disorders. Prostacyclin, given by continuous infusion, is even if they do not respond challenge. long term benefit these thought reflect antiproliferative effects drug and/or its ability inhibit platelet aggregation. It either therapy bridge transplantation. Inhaled oxide, which mainly newborn, has particular being selective, due route administration rapid inactivation. Anticoagulants specific role thromboembolic also routinely Nondrug treatments for include supplemental oxygen (> = h/day), chronic obstructive disease heart-lung transplantation, nowadays regarded resort. Different types require different strategies. Future may come from combinations, development new drugs, such endothelin donors potassium channel openers, application gene therapy.