Pulmonary Arterial Hypertension (Therapeutic Strategies) by J. A. Barbera, A. J. Peacock

By J. A. Barbera, A. J. Peacock

Pulmonary arterial high blood pressure (PAH) is an extraordinary situation. This paintings stories the advancements in our realizing of the disorder, advances in remedy and opinion on most sensible perform techniques to administration.

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Sample text

Some patients have been safely transitioned from intravenous epoprostenol to subcutaneous treprostinil, but attempts like this should be performed only in experienced centres with the patient under careful clinical and haemodynamic surveillance. ORAL PROSTANOIDS: BERAPROST SODIUM AND ORAL TREPROSTINIL Beraprost is an orally active prostacyclin analogue. Under fasting conditions, beraprost is rapidly absorbed; peak plasma concentrations are reached after 30 min, and the elimination half-life is 30–45 min.

The largest randomised, placebo-controlled trial performed to date in patients with PAH included 470 patients in functional classes II, III and IV and found a statistically significant increase in 6MWD compared to placebo after 12 weeks of treatment [10]. Although statistically significant, the mean improvement was only 16 m. There was a clear dosedependent relationship with the greatest improvements seen in those patients who could tolerate the highest doses. Several haemodynamic variables including right atrial pressure, pulmonary arterial pressure, cardiac output, pulmonary vascular resistance and mixed Current treatment of PAH 37 venous oxygen saturation were also significantly improved in the treprostinil group.

A phase II trial with BAY 63-2521 in patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH) was recently concluded but the results are not yet available. This compound will now be studied in phase III trials in PAH and CTEPH, as well as in phase II studies in patients with pulmonary hypertension associated with interstitial lung disease (ILD). SUMMARY Prostanoids and PDE-5 inhibitors, together with endothelin receptor antagonists, have become the mainstays of PAH treatment.

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