PMID- 15939821
OWN - NLM
STAT- MEDLINE
DCOM- 20060206
LR  - 20231024
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 111
IP  - 23
DP  - 2005 Jun 14
TI  - Long-term response to calcium channel blockers in idiopathic pulmonary arterial 
      hypertension.
PG  - 3105-11
AB  - BACKGROUND: Characteristics of patients with idiopathic pulmonary arterial 
      hypertension (IPAH) who benefit from long-term calcium channel blockers (CCB) are 
      unknown. METHODS AND RESULTS: Acute pulmonary vasodilator testing with 
      epoprostenol or nitric oxide was performed in 557 IPAH patients. Acute 
      responders, defined by a fall in both mean pulmonary artery pressure (PAP) and 
      pulmonary vascular resistance (PVR) >20%, received long-term oral CCB. Patients 
      who benefit from long-term CCB were defined as those being in New York Heart 
      Association (NYHA) functional class I or II after at least 1 year on CCB 
      monotherapy. Among the 70 patients who displayed acute pulmonary vasoreactivity 
      (12.6%; 95% CI, 9.8% to 15.3%) and received CCB therapy, only 38 showed long-term 
      improvement (6.8%; 95% CI, 4.7% to 8.9%). Long-term CCB responders had less 
      severe disease at baseline than patients who failed. During acute vasodilator 
      testing, long-term CCB responders displayed a more pronounced fall in mean PAP 
      (-39+/-11% versus -26+/-7%; P<0.0001), reaching an absolute value of mean PAP 
      lower than that measured in patients who failed (33+/-8 versus 46+/-10 mm Hg; 
      P<0.0001). After 7.0+/-4.1 years, all but 1 long-term CCB responders were alive 
      in NYHA class I or II, with a sustained hemodynamic improvement. In the group of 
      patients who failed on CCB, the 5-year survival rate was 48%. CONCLUSIONS: 
      Long-term CCB responders represent <10% of IPAH patients evaluated in a pulmonary 
      vascular referral center. During acute vasodilator testing, these patients showed 
      significantly lower levels of both mean PAP and PVR, which reached near-normal 
      values.
FAU - Sitbon, Olivier
AU  - Sitbon O
AD  - Centre des Maladies Vasculaires Pulmonaires, UPRES EA 2705, Service de 
      Pneumologie et Reanimation Respiratoire, Hopital Antoine Beclere, AP-HP, 
      Universite Paris-Sud, Clamart, France. olivier.sitbon@abc.aphp.fr
FAU - Humbert, Marc
AU  - Humbert M
FAU - Jais, Xavier
AU  - Jais X
FAU - Ioos, Vincent
AU  - Ioos V
FAU - Hamid, Abdul M
AU  - Hamid AM
FAU - Provencher, Steeve
AU  - Provencher S
FAU - Garcia, Gilles
AU  - Garcia G
FAU - Parent, Florence
AU  - Parent F
FAU - Herve, Philippe
AU  - Herve P
FAU - Simonneau, Gerald
AU  - Simonneau G
LA  - eng
PT  - Journal Article
DEP - 20050606
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Calcium Channel Blockers)
RN  - 0 (Vasodilator Agents)
RN  - 31C4KY9ESH (Nitric Oxide)
RN  - DCR9Z582X0 (Epoprostenol)
SB  - IM
MH  - Adult
MH  - Calcium Channel Blockers/*pharmacology/therapeutic use
MH  - Drug Evaluation
MH  - Epoprostenol
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/etiology/mortality
MH  - Male
MH  - Middle Aged
MH  - Nitric Oxide
MH  - Pulmonary Artery/physiopathology
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Vasodilation/drug effects
MH  - Vasodilator Agents
EDAT- 2005/06/09 09:00
MHDA- 2006/02/07 09:00
CRDT- 2005/06/09 09:00
PHST- 2005/06/09 09:00 [pubmed]
PHST- 2006/02/07 09:00 [medline]
PHST- 2005/06/09 09:00 [entrez]
AID - CIRCULATIONAHA.104.488486 [pii]
AID - 10.1161/CIRCULATIONAHA.104.488486 [doi]
PST - ppublish
SO  - Circulation. 2005 Jun 14;111(23):3105-11. doi: 10.1161/CIRCULATIONAHA.104.488486. 
      Epub 2005 Jun 6.