Inhaled nitric oxide as a screening agent for safely identifying responders to oral calcium-channel blockers in primary pulmonary hypertension
| Autor: | O Taravella, Florence Parent, P Hervé, J. L. Jagot, Muriel Fartoukh, G. Simonneau, Olivier Sitbon, Marc Humbert |
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| Rok vydání: | 1998 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Time Factors Nifedipine Hypertension Pulmonary Administration Oral Hemodynamics Nitric Oxide Nitric oxide Diltiazem chemistry.chemical_compound medicine.artery Administration Inhalation medicine Humans Prospective Studies Pulmonary Wedge Pressure Adverse effect Prospective cohort study Dose-Response Relationship Drug Inhalation business.industry Respiratory disease Middle Aged Calcium Channel Blockers medicine.disease Pulmonary hypertension chemistry Anesthesia Pulmonary artery Female Vascular Resistance business |
| Zdroj: | European Respiratory Journal. 12:265-270 |
| ISSN: | 1399-3003 0903-1936 |
| DOI: | 10.1183/09031936.98.12020265 |
| Popis: | In a subset of patients with primary pulmonary hypertension (PPH), high doses of oral calcium-channel blockers (CCB) produce a sustained clinical and haemodynamic improvement. However, significant side-effects have been reported during acute testing with CCB. Therefore, to identify accurately patients who may benefit from long-term CCB therapy, there is a need for a safe, potent and short-acting vasodilator. The aim of this study was to compare the acute response to inhaled nitric oxide (NO) and oral high doses of CCB in 33 consecutive patients with PPH. A significant acute vasodilator response was defined by a fall in both mean pulmonary artery pressure and total pulmonary resistance by >20%. Ten patients responded acutely to NO, nine of whom responded acutely to CCB, without any complications. The 23 other patients failed to respond to NO and CCB. In these nonresponders, nine serious adverse events were observed with CCB (38%). There was no clinical or baseline haemodynamic feature predicting acute vasodilator response. Long-term oral treatment with CCB was restricted to the nine acute responders and a sustained clinical and haemodynamic improvement was observed in only six patients. In primary pulmonary hypertension, the acute response rate to high doses of calcium-channel blockers is low (27%). Serious adverse reactions to high doses of calcium-channel blockers during acute testing are frequently observed in nonresponders. It is concluded that nitric oxide may be used as a screening agent for safely identifying patients with primary pulmonary hypertension who respond acutely to calcium-channel blockers and may benefit from long-term treatment with these agents. |
| Databáze: | OpenAIRE |
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