Skip to main content


Log in

Analysis of the structure of the muscular pulmonary arteries in patients with pulmonary hypertension and COPD: National Institutes of Health Nocturnal Oxygen Therapy Trial

  • Published:
Lung Aims and scope Submit manuscript


We examined the cardiovascular function as well as the structure of the muscular pulmonary arteries in patients who had died while enrolled in the National Institutes of Health nocturnal oxygen therapy trial (NOTT). The cardiovascular function of the patients classified into groups based on the severity of the pulmonary hypertension was examined, and we compared the morphologic data in these groups to those obtained from age-matched controls who died with no evidence of cardiovascular disease. The groups with severe pulmonary hypertension had markedly increased pulmonary vascular resistance but similar cardiac index to the group with only mild hypertension. In the structural analyses, we found definite alterations in arterial structure from the control population: the patients who had pulmonary hypertension had markedly increased percentages of intima and media. These differences were most pronounced in the medium and larger muscular arteries. The degree of pulmonary hypertension did not appear to alter vascular structure consistently, although there was a trend towards an increase in muscle media in the smaller vessels. When the patients were classified into a group who responded to oxygen administration by a decrease in Ppa, and an age- and Ppa-matched group who did not respond, there were no differences in vascular structure between these groups, although both groups had greater percentages of intima and media compared to the control group. We conclude that, in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD), there are structural alterations of the muscular pulmonary arteries, but these do not correlate with either the severity of the pulmonary hypertension or the ability of the pulmonary vasculature to respond to oxygen administration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Agusti AGN, Barbera JA, Roca J, Wagner PD, Guitart R, Rodriguez-Roisin R (1990) Hypoxic pulmonary vasoconstriction and gas exchange during exercise in chronic obstructive pulmonary disease. Chest 97:268–275

    Google Scholar 

  2. Bove KE, Rowlands DT, Scott RC (1966) Observations on the assessment of cardiac hypertrophy utilizing a chamber partition technique. Circulation 33:558–568

    Google Scholar 

  3. Boysen PG, Block AJ, Wynne JW, Hunt LA, Flick MR (1976) Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chest 1:117–124

    Google Scholar 

  4. Burrows B, Kettel LJ, Niden AH, Rabinowitz M, Diener CF Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 286:912–918, 1972

    Google Scholar 

  5. Caslin AW, Heath D, Madden B, Yacoub M, Gosmey JR, Smith P (1990) The histopathology of 36 cases of plexogenic pulmonary arteriopathy. Histopathology 16:9–19

    Google Scholar 

  6. Cooper R, Ghali J, Simmons BF, Castaner A Elevated pulmonary artery pressure: an independent predictor of mortality. Chest 99:112–120, 1991

    Google Scholar 

  7. Crouch CE, Parks WC, Rosenbaum JL, Chang D, Whitehouse L, Wu L, Stenmark KR, Orton EC, Mecham RP (1989) Regulation of collagen production by medial smooth muscle cells in hypoxic pulmonary hypertension. Am Rev Respir Dis 140:1045–1051

    Google Scholar 

  8. Davies P, Maddalo F, Reid L (1985) Effects of chronic hypoxia on structure and reactivity of rat lung microvessels. J Appl Physiol 58:795–801

    Google Scholar 

  9. Fernie JM, Lamb D (1988) Assessment of the effects of age and smoking on the media of muscular pulmonary arteries. J Pathol 155:241–246

    Google Scholar 

  10. Fletcher EC, Levin DC (1984) Cardiopulmonary hemodynamics during sleep in subjects with chronic obstructive pulmonary disease. The effect of short and long-term oxygen. Chest 85:6–14

    Google Scholar 

  11. Fulton RM, Hutchinson EC, Jones AM (1952) Ventricular weight in cardiac hypetrophy. Br Heart J 14:413–420

    Google Scholar 

  12. Hale EA, Ewing SL, Gosnell BA, Niewoehner DE (1984) Lung disease in long-term cigarette smokers with and without chronic air-flow obstruction. Am Rev Respir Dis 130:716–721

    Google Scholar 

  13. Magee F, Wright JL, Wiggs BR, Pare PD, Hogg JC (1988) Pulmonary vascular structure and function in chronic obstructive pulmonary disease. Thorax 43:183–189

    Google Scholar 

  14. Mecham RP, Whitehouse LA, Wrenn DS, Parks WC, Griffin GL, Senior RM, Crouch EC, Stenmark KR, Voelkel NF (1987) Smooth muscle-mediated connective tissue remodeling in pulmonary hypertension. Science 237:423–426

    Google Scholar 

  15. Murray TR, Chen L, Marchall BE, Macarak EJ (1990) Hypoxic contraction of cultured pulmonary vascular smooth muscle cells. Am J Respir Mol Biol 3:457–465

    Google Scholar 

  16. Nocturnal Oxygen Therapy Trial Group (1980) Continuous or nocturnal oxygen therapy in hypoxemia chronic obstructive lung disease. Ann Intern Med 93:391–398

    PubMed  Google Scholar 

  17. Ohar JA, Pyle JA, Waller KS, Hyers TM, Webster RO, Lagunoff D (1990) A rabbit model of pulmonary hypertension induced by the synthetic platelet-activating factor acetylglyceryl ether phosphorylcholine. Am Rev Respir Dis 141:104–110

    Google Scholar 

  18. Peacock AJ, Pickett C, Morris K, Reeves JT (1989) The relationship between rapid growth and pulmonary hemodynamics in the fast-growing broiler chicken. Am Rev Respir Dis 139:1524–1530

    Google Scholar 

  19. Riley DJ, Poiani GJ, Tozzi CA (1990) Mechanisms of increased vascular collagen content in hypoxic pulmonary hypertension Prog Respir Res 26:39–46

    Google Scholar 

  20. Selinger SR, Kennedy TP, Buescher P, Terry P, Parham W, Gofreed D, Medinger A, Spagnolo SV, Michael JR (1987) Effects of removing oxygen from patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 136:85–91

    Google Scholar 

  21. Stuart-Harris C, Bishop JM, Clark TJH, Dornhorst AC, Cotes JE, Flenley DC, Howard P, Oldham PD (1981) Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet March, Vol. I, 28:681–685

    Google Scholar 

  22. Thurlbeck WM, Dunnill MS, Hartund W (1972) A comparison of three methods of measuring emphysema. Hum Pathol 1:215–226

    Google Scholar 

  23. Timms RM, Khaja FU, Williams GW (1985) Hemodynamic response to oxygen therapy in chronic obstructive pulmonary disease. Ann Intern Med 102:29–36

    Google Scholar 

  24. Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Pelletier A (1985) Long-term oxygen therapy can reverse the progression of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 131:493–498

    Google Scholar 

  25. Wilkinson L (1988) SYSTAT: The System for Statistics. Evanston, IL: SYSTAT, Inc.

    Google Scholar 

  26. Wilkinson M, Langhorne CA, Heath D, Barer GR, Howard P (1988) A pathophysiological study of 10 cases of hypoxic cor pulmonale. Q J Med 249:65–85

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Additional information

Offprint requests to: J. L. Wright

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wright, J.L., Petty, T. & Thurlbeck, W.M. Analysis of the structure of the muscular pulmonary arteries in patients with pulmonary hypertension and COPD: National Institutes of Health Nocturnal Oxygen Therapy Trial. Lung 170, 109–124 (1992).

Download citation

  • Accepted:

  • Issue Date:

  • DOI:

Key words