Treatment Of Idiopathic Pulmonary Hypertension Research Articles

Inefficacy of Sildenafil treatment of idiopathic pulmonary hypertension

There were studied effects of phosphodiesterase inhibitor Sildenafil on clinical and functional status in young patient with severe primary pulmonary hypertension. Sildenafil was applicated in dose of 50-100 mg daily for 12 weeks, clinical and functional status were estimated initial and after every month of treatment. The retrospective analysis do not detected any positive dynamics in all estimated parameters, this phenomena may be explained by individual patient refractivity on this group of medicine.

Клинический случай идиопатической легочной гипертензии, осложненной тромбозом in situ (9-летнее наблюдение)

The article presents a clinical case of idiopathic pulmonary hypertension complicated by thrombosis in situ (9-year follow-up). Possible pathogenetic mechanisms of the disease development are analyzed. The difficulties of differential diagnosis and the treatment of idiopathic pulmonary hypertension are discussed.

The first Russian experience of sildenafil application in patients with idiopathic pulmonary hypertension

Over the last decade, the interest in the treatment of idiopathic pulmonary hypertension (IPAH) has greatly increased because of the development and implementation of innovative therapeutic approaches. One of the modern drug groups for the treatment of pulmonary arterial hypertension are phosphodiesterase type 5 inhibitors (PDE5), which can cause pulmonary vasodilation via a NO-dependent mechanism.The aim of the research was to study the efficacy and safety of sildenafil treatment in patients with IPAH received 16-week course and to study sildenafil impact on clinical, hemodynamic and functional status.Material and methods: 20 patients with IPAH (mean age 40.9±11.5 years) functional class (FC) II-IV (WHO), who were receiving standard therapy (anticoagulants, diuretics, glycosides, calcium antagonists), were prescribed sildenafil 20 mg three times a day for 16 weeks. Initially, and after 16 weeks of treatment we studied FC, and the results of the six-minute walk test (6MWT), transthoracic echocardiography (ECHO), right heart catheterization (RHC) and laboratory tests to determine the safety of the therapy were carried out, as well.Results: the group of patients had 6MWT distance of 344±116 m at the beginning of the study. For about 90% of the patients suffered from dizziness, 75% - from the pain in the heart, 65% of the patients had edema and 35% - hepatomegaly. The patients suffered from severe pulmonary hypertension according to the functional and hemodynamic status. The estimated pulmonary artery systolic pressure (PASP) according to ECHO results was 89.6±22 mm Hg. According to the data from RHC we noted the elevation of mean pulmonary arterial pressure (mPAP) to 56.3±19 mm Hg, of pulmonary vascular resistance (PVR) to 1218±709 dyne/sec x per x cm-5 and the decrease in cardiac output (CO) - 3.4±0.8 l/min/m2.There were slight increasing in 6MWT distance (+23 m, p>0.05) and a statistically significant improvement in clinical status in comparison with the initial data: dizziness - 71%, heart pain - 38%, edema and hepatomegaly were observed in 15% and 14% (p

Clinical case: combination therapy with iloprost and sildenafil in the treatment of idiopathic pulmonary hypertension

Idiopathic pulmonary arterial hypertension is a rare disease with unknown etiology, characterized by progressive increase in pulmonary vessel resistance, right heart failure. Combined pathogenetic therapy using leads to depression of disease progression, repeated hospitalization, improvement in disease prognosis in patients with III-IV functional class (WHO).The patient with diagnosis of idiopathic pulmonary arterial hypertension, verified by right heart catheterization method, functional class III (WHO) was treated by anticoagulants, diuretics. There were observed the negative dynamic with right heart chambers dilation, appearing of heart failure signs during the treatment with phosphodiesterase type 5-inhibitor sildenafil. After adding an inhaled form of prostanoids-iloprost to sildenafil therapy there was achieved the significant improvement of the functional and hemodynamic status. Reduction in dyspnoea level, improvement in physical activity tolerance and disease prognosis were reached.

Первый российский опыт применения силденафила у больных идиопатической легочной гипертензией

Over the last decade, the interest in the treatment of idiopathic pulmonary hypertension (IPAH) has greatly increased because of the development and implementation of innovative therapeutic approaches. One of the modern drug groups for the treatment of pulmonary arterial hypertension are phosphodiesterase type 5 inhibitors (PDE5), which can cause pulmonary vasodilation via a NO-dependent mechanism.The aim of the research was to study the efficacy and safety of sildenafil treatment in patients with IPAH received 16-week course and to study sildenafil impact on clinical, hemodynamic and functional status.Material and methods: 20 patients with IPAH (mean age 40.9±11.5 years) functional class (FC) II-IV (WHO), who were receiving standard therapy (anticoagulants, diuretics, glycosides, calcium antagonists), were prescribed sildenafil 20 mg three times a day for 16 weeks. Initially, and after 16 weeks of treatment we studied FC, and the results of the six-minute walk test (6MWT), transthoracic echocardiography (ECHO), right heart catheterization (RHC) and laboratory tests to determine the safety of the therapy were carried out, as well.Results: the group of patients had 6MWT distance of 344±116 m at the beginning of the study. For about 90% of the patients suffered from dizziness, 75% - from the pain in the heart, 65% of the patients had edema and 35% - hepatomegaly. The patients suffered from severe pulmonary hypertension according to the functional and hemodynamic status. The estimated pulmonary artery systolic pressure (PASP) according to ECHO results was 89.6±22 mm Hg. According to the data from RHC we noted the elevation of mean pulmonary arterial pressure (mPAP) to 56.3±19 mm Hg, of pulmonary vascular resistance (PVR) to 1218±709 dyne/sec x per x cm-5 and the decrease in cardiac output (CO) - 3.4±0.8 l/min/m2.There were slight increasing in 6MWT distance (+23 m, p>0.05) and a statistically significant improvement in clinical status in comparison with the initial data: dizziness - 71%, heart pain - 38%, edema and hepatomegaly were observed in 15% and 14% (p<0.05) of the cases, respectively, during 4 weeks of therapy. ECHO showed statistically significant reduction of estimated PASP - 83±14 mm Hg (p<0.05). We noted a statistically significant increase in 6MWT distance +112 towards 16 week of treatment in comparison with the initial data (p<0.05). We noted a statistically significant reduction of PASP (from 89.6±23.1 mm Hg to 75.2±14 mm Hg, p<0.05), according to the data from ECHO. At the end of 16 weeks of sildenafil treatment all patients demonstrated no edema and hepatomegaly; dizziness was diagnosed only in 26% of the cases (p<0.05), heart pain - in 10%. Sildenafil treatment demonstrated statistically significant dynamics of key hemodynamic characteristics using RHC - mPAP (-9,3 mm Hg), PVR (235 dyne/sec x per x cm-5), CO (-0.4 l/min/m2).On the background of sildenafil therapy the patients had following side effects: palpitations - 3 patients (15%), hot flashes - 2 patients (10%), headache - 1 patient (5%), systemic hypotension - 3 patients (15%). All mentioned side effects occurred within the first 2-3 days of therapy and were minor and did not cause dose correction.Conclusions. The application of sildenafil in dose of 60 mg per day in patients with IPAH within 16 weeks had resulted in a significant increase in 6MWT, improvement of FC and hemodynamic parameters according to the data from ECHO and RHC. Therapy characterized by a good tolerance and accompanied by no clinically significant side-effects.

The clinical efficay of bosentan for idiopathic pulmonary arterial hypertension

Objective To explore the efficacy of bosentan in the treatment of idiopathic pulmonary arterial hypertension ( IPAH ).Methods 45 patients with IPAH were randomly assigned to study group ( 23 patients ) or control group ( 22 patients ).Both groups received conventional therapies and the study group was administered oral bosentan additionally.The efficacy was then analyzed in the two groups.Results 14 days after treatment,levels of PaO2 and 6MWD were higher whereas levels of PaCO2 and PAP were lower in the study group than in the control group [( 81 ± 3.7 )mmHg ( 1 mm Hg=0.133 kPa ) vs.( 57.0 ± 3.9 ) mm Hg and ( 331.0 ± 81.2 ) m vs.( 263.0 ± 58.9 ) m,and ( 43.0 ± 5.9 ) mmHg vs.( 66.0 ± 7.2 ) mm Hg and ( 63.0 ± 17.1 )mm Hg vs.( 78.0 ± 16.7 ) mm Hg; P ＜ 0.05 for all comparisons].Conclusions Oral bosentan is efficacious in the treatment of idiopathic pulmonary arterial hypertension,significantly reducing high pressure of pulmonary artery. Key words: Bosentan; Idiopathic pulmonary arterial hypertension

Microvascular Complications in Diabetic Erectile Dysfunction

Advances in the management of erectile dysfunction (ED) and its adverse effects on the quality of life of men and their partners have encouraged researchers to look for new solutions for treating and curing ED. The introduction of phosphodiesterase type 5 inhibitors to treat ED in 1998 was revolutionary in that it heralded the onset of a new era of effective and safe treatment for restoring male sexual function. Today, PDE5 inhibitors are used as first-line therapy for the management of ED irrespective of its etiology. Despite the fact that millions of men with ED worldwide have been treated successfully with these drugs, several questions regarding their efficacy and safety and the high dropout rate in men to whom these medications are prescribed remain unanswered. This is especially evident in diabetes because the frequency of ED in men with diabetes is higher than that of the general population. In fact, the frequency of ED in diabetic men has been reported to be as high as 75% in men with longstanding disease (1–3). In contrast to the high efficacy rate of PDE5 inhibitors in the general population (70–89%), just over 50% of diabetic men with ED respond favorably to these drugs (4). Impaired neural and penile vascular functions are believed to be the main reasons for the high incidence of ED in men with diabetes, and the underlying causes of this drug resistance are not fully understood. Recent data indicate that PDE5 inhibitors have beneficial effects in other chronic diseases. Sildenafil has been approved recently for the treatment of idiopathic pulmonary hypertension (5). Lately, several reports have suggested that PDE5 inhibitors may improve arterial function (6–9). Moreover, improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia has also been reported (10). Finally, the results …

Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence

Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, doubleblind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action--within 14 minutes for some men--and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.