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Treatment of pulmonary hypertension with selective pulmonary vasodilators

Haj, Reem M.a; Cinco, J. Erricb; Mazer, C. Davidb

Current Opinion in Anaesthesiology: February 2006 - Volume 19 - Issue 1 - p 88-95
doi: 10.1097/01.aco.0000192765.27453.5a
Cardiovascular anaesthesiology
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Purpose of review Pulmonary vasodilators are important in the management of pulmonary hypertension. Although systemic vasodilators may be effective in lowering pulmonary artery pressure, systemic vasodilation is the main limitation to dose titration. This review summarizes the latest research and developments in pulmonary vasodilators in the management of acute and chronic pulmonary hypertension.

Recent findings Nitric oxide, the prototype of selective pulmonary vasodilators, remains an effective option in the management of pulmonary hypertension; however, cost and complexity of administration have led to consideration of other pulmonary vasodilators. Animal research suggests that nitric oxide may have an important role in the prevention of pulmonary hypertension after cardiopulmonary bypass. Experience with phosphodiesterase inhibitors, as monotherapy or as part of combination therapy, suggests that these agents improve cardiopulmonary hemodynamics and can be considered as alternatives and/or adjuncts to nitric oxide. Prostacyclins are a versatile class of pulmonary vasodilator as they have been shown to improve pulmonary hemodynamics administered intravenously or via inhalation. Endothelin receptor antagonists have been shown to be effective for long-term management of pulmonary hypertension. Several gene therapy strategies are currently undergoing evaluation.

Summary Selective pulmonary vasodilation can be achieved through delivery of vasodilators directly to the lungs or targeting pulmonary specific processes. Several therapeutic options are available that demonstrate selectivity for the pulmonary vasculature. These agents can facilitate optimization of cardiopulmonary hemodynamics.

aDepartment of Pharmacy, St. Michael's Hospital, Toronto, Canada

bDepartments of Anesthesia and Critical Care, St. Michael's Hospital, University of Toronto, Toronto, Canada

Correspondence to C. David Mazer MD, FRCPC, Professor of Anesthesia, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON Canada M5B IW8. Tel: +416 864 5825, fax: +416 864 6014; E-mail: mazerd@smh.toronto.on.ca

© 2006 Lippincott Williams & Wilkins, Inc.