What Is The Treatment For Pulmonary Hypertension?

What Is The Treatment For Pulmonary Hypertension?

The aim of the treatment for pulmonary hypertension is to control the symptoms of the disease and to slow down the progression of the same.

The type of treatment for pulmonary hypertension depends on the type of the pathology involved like whether the pulmonary hypertension is due to – arterial, venous, thromboembolic or due to hypoxia. If the pulmonary hypertension is due to cardiac dysfunction then the aim of the therapy is to treat the cardiac cause either by medication or surgical intervention. Different classes of drugs have been recently introduced for the treatment of primary and secondary pulmonary hypertension. These drugs are of various classes as vasoactive substances, anticoagulants, phosphodiesterase inhibitors.

What Is The Treatment For Pulmonary Hypertension?

Vasoactive Substance- Many pathways are involved in the pathogenesis of pulmonary hypertension leading to abnormal proliferation and contraction of the smooth muscle. These pathways are specially targeted by different classes of the group.

Prostaglandins- Prostaglandin I2 also known as Prostacyclin is the most effective treatment for the pulmonary arterial hypertension. These drugs are given through continuous infusion. This system of delivery may cause sepsis and thrombosis. Recently other congeners have been developed, which can be safely administered either intravenously or subcutaneously. And some are with the longer half-life.

Endothelin Receptor Antagonist- Endothelin is a substance that is secreted by the wall of blood vessels. The effect of endothelin release causes the narrowing of these blood vessels that causes vasoconstriction. These drugs should not be given to pregnant ladies. These drugs have adverse effects on liver causing liver damage. Due to hepatotoxic effect of these drugs constant monitoring is mandatory in patients taking them.

Phosphodiesterase 5 Inhibitors- Phosphodiesterase inhibitors are used to treat the Pulmonary Hypertension. They act by dilating the narrowed blood vessels in the lung parenchyma and allow the flow of blood with ease. Adverse effects include a headache, nausea, gastrointestinal disturbance. Sildenafil (Viagra) and tadalafil are the two commonly used drugs of this class.

Calcium Channel Blockers- Calcium channel blockers are the drugs which relax the muscles present in the vessels wall. Besides their muscles relaxant property they can provide relief to patients but are relatively less commonly used nowadays. These drugs include amlodipine, diltiazem, and nifedipine.

Soluble Guanylate Cyclases Stimulator- Soluble Guanylate cyclases are the intracellular Receptor for NO. They Decrease the Pulmonary Hypertension tension and lower the pressure within arterioles.

Digoxin- It is a cardiac glycoside. It causes the heart musculature to contract more strongly and pump more blood. It is basically an antiarrhythmic drug.

Diuretics- Diuretics are used to treat pulmonary hypertension as they excrete out the excess amount of water from the body. These drugs help to lower cardiac load and also prevent the accumulation of fluid in lung parenchyma.

Oxygen- Oxygen therapy is sometimes used to treat Pulmonary Hypertension in patients living at higher altitudes. In advance cases of Pulmonary Hypertension, patients may require continuous oxygen therapy.

Surgical Management For Pulmonary Hypertension

Atrial Septostomy- If medical management of pulmonary hypertension fails or is non- responsive patient, surgical management is the next option available for these patients. Atrial septostomy is an open heart surgery. Atrial septostomy is a surgical procedure for the treatment of Pulmonary Hypertension in which the surgeon makes an opening between the upper chambers of heart i.e. between right and left atrium to relieve the pressure within the right chamber. There is shunting of blood from right Atrium to left Atrium, therefore there is mixing of blood in the Chambers causing a decrease in the level of oxygen to the tissues. Cardiac arrhythmias are the associated complication of atrial septostomy.

Thromboendarterectomy is a surgical treatment of choice in the cases of thromboembolic pulmonary hypertension. In this procedure, the thrombus is removed from within the lumen of pulmonary vessels through sophisticated technology. As this is a new technique so it is performed only a few selected centers.

Transplantation- Lung transplantation treatment is done in those patients where above procedures cannot be performed. Transplantation of the lung can cure pulmonary hypertension but the complications of transplantation are the main concern for the doctors. Organ rejection, graft versus host reaction, Anaphylactic shock are some of the complications of transplantation. This also compiles the patient to take steroid throughout the life.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 28, 2018

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