PMID- 20732614
OWN - NLM
STAT- MEDLINE
DCOM- 20100920
LR  - 20161209
IS  - 2213-0276 (Electronic)
IS  - 0755-4982 (Linking)
VI  - 39 Suppl 1
DP  - 2010 Jun
TI  - [Treatment of pulmonary arterial hypertension].
PG  - 1S22-32
LID - 10.1016/S0755-4982(10)70004-X [doi]
AB  - Treatment of pulmonary arterial hypertension (PAH) attempts to counteract the 
      deleterious effects of pulmonary vasoconstriction, pulmonary vascular remodeling, 
      thrombosis and right heart dysfunction. The development of therapies targeting 
      the endothelial dysfunction (endothelin-receptor antagonists, prostacyclin 
      derivatives, phosphodiesterase type 5 inhibitors) has markedly improved patients' 
      prognosis. Intravenous epoprostenol remains the first line treatment for the most 
      severe patients (NYHA [New York Heart Association] functional class IV). In this 
      situation, initial combination therapy with epoprostenol and either an 
      endothelin-receptor antagonist (ERA) or a phosphodiesterase type 5 inhibitor 
      (PDE5 I), or both should also be discussed. Patients in functional class III 
      should be considered candidates for treatment with either an ERA or a PDE5 I, or 
      a prostanoid. Patients who are in functional class II should be treated with an 
      ERA or a PDE5 I. In the case of inadequate clinical response with a first line 
      therapy, sequential combination therapy should be considered. Combination therapy 
      can include either an ERA plus a PDE5 I,or a prostanoid plus an ERA, or a 
      prostanoid plus a PDE5 I and sometimes a triple therapy. Recommendations in 
      pediatric PAH are equivalent to those proposed in adults. Randomised studies are 
      rare and pharmacokinetics data for available drugs are scarce. The impact of 
      these new therapeutic approaches on long-term survival of patients with PAH is a 
      major challenge in the near future.
FAU - Jais, Xavier
AU  - Jais X
AD  - Universite Paris-Sud XI, Orsay, France. xavier.jais@abc.aphp.fr
FAU - Bonnet, Damien
AU  - Bonnet D
LA  - fre
PT  - English Abstract
PT  - Journal Article
TT  - Traitement de l'hypertension arterielle pulmonaire.
PL  - France
TA  - Presse Med
JT  - Presse medicale (Paris, France : 1983)
JID - 8302490
RN  - 0 (Anticoagulants)
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Calcium Channel Blockers)
RN  - 0 (Diuretics)
RN  - 0 (Endothelin Receptor Antagonists)
RN  - 0 (Phosphodiesterase Inhibitors)
RN  - 0 (Prostaglandins I)
RN  - DCR9Z582X0 (Epoprostenol)
SB  - IM
MH  - Adult
MH  - Algorithms
MH  - Anticoagulants/therapeutic use
MH  - Antihypertensive Agents/therapeutic use
MH  - Calcium Channel Blockers/therapeutic use
MH  - Child
MH  - Combined Modality Therapy
MH  - Decision Trees
MH  - Diuretics/therapeutic use
MH  - Drug Therapy, Combination
MH  - Endothelin Receptor Antagonists
MH  - Epoprostenol/therapeutic use
MH  - Heart Atria/surgery
MH  - Humans
MH  - Hypertension, Pulmonary/*therapy
MH  - Life Style
MH  - Oxygen Inhalation Therapy
MH  - Patient Selection
MH  - Phosphodiesterase Inhibitors/therapeutic use
MH  - Practice Guidelines as Topic
MH  - Prostaglandins I/therapeutic use
EDAT- 2010/09/03 06:00
MHDA- 2010/09/21 06:00
CRDT- 2010/08/25 06:00
PHST- 2010/08/25 06:00 [entrez]
PHST- 2010/09/03 06:00 [pubmed]
PHST- 2010/09/21 06:00 [medline]
AID - S0755-4982(10)70004-X [pii]
AID - 10.1016/S0755-4982(10)70004-X [doi]
PST - ppublish
SO  - Presse Med. 2010 Jun;39 Suppl 1:1S22-32. doi: 10.1016/S0755-4982(10)70004-X.