[Update pulmonary arterial hypertension : Definitions, diagnosis, therapy]

Internist (Berl). 2017 Sep;58(9):937-957. doi: 10.1007/s00108-017-0301-5.
[Article in German]

Abstract

The term pulmonary arterial hypertension comprises a group of pulmonary vascular diseases of different etiologies that are characterized by similar precapillary vascular remodeling processes and result in exertional dyspnea and right heart insufficiency. The specific pharmacological treatment approach considers the risk of mortality and phenotypical properties and includes treatment with phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostanoids, as well as with more novel substances, such as a soluble guanylyl cyclase stimulator and an oral prostacyclin receptor agonist. The prognosis of the disease is mainly determined by the right heart insufficiency for which there is currently no specific pharmacological treatment. Lung transplantation may be offered as a last option. This review provides an overview of the current European guidelines from 2015 and the recommendations of the Cologne Consensus Conference for pulmonary hypertension from 2016.

Keywords: Endothelin receptor antagonists; Guanylyl cyclase, soluble; Phosphodiesterase type 5 inhibitors; Prostacyclin receptor; Prostanoids.

MeSH terms

  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use
  • Dyspnea / diagnosis
  • Dyspnea / drug therapy
  • Dyspnea / etiology
  • Endothelin Receptor Antagonists / adverse effects
  • Endothelin Receptor Antagonists / therapeutic use
  • Guanylate Cyclase
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / drug therapy*
  • Hypertension, Pulmonary / etiology
  • Phosphodiesterase 5 Inhibitors / adverse effects
  • Phosphodiesterase 5 Inhibitors / therapeutic use
  • Prognosis
  • Prostaglandins / adverse effects
  • Prostaglandins / therapeutic use
  • Receptors, Epoprostenol / agonists
  • Risk Factors
  • Vascular Remodeling / physiology
  • Ventricular Dysfunction, Right / diagnosis
  • Ventricular Dysfunction, Right / drug therapy
  • Ventricular Dysfunction, Right / etiology

Substances

  • Antihypertensive Agents
  • Endothelin Receptor Antagonists
  • PTGIR protein, human
  • Phosphodiesterase 5 Inhibitors
  • Prostaglandins
  • Receptors, Epoprostenol
  • Guanylate Cyclase