Zusammenfassung
Die pulmonale Hypertonie (PH) ist eine chronisch progrediente Erkrankung der pulmonalen Zirkulation multifaktorieller Ursache. Die aktuelle diagnostische Klassifikation der PH unterscheidet fünf Hauptgruppen, die als Gemeinsamkeit einen erhöhten mittleren pulmonalarteriellen Druck und pulmonalen Gefäßwiderstand aufweisen. Klassifiziert werden die pulmonalarterielle Hypertonie (PAH), die PH durch Linksherzerkrankung, die PH bei Lungenerkrankungen und/oder Hypoxie, die chronische thromboembolische pulmonale Hypertonie (CTEPH) und die PH mit unklaren bzw. multifaktoriellen Mechanismen. Aktuelle Fortschritte in der Grundlagenforschung sowie die Zulassung neuer Medikamente und Etablierung von Therapiestrategien vor allem bei der PAH und CTEPH erfordern eine differenzierte Betrachtung der Erkrankung, eine sorgfältige Diagnosestellung und Therapieeinleitung sowie regelmäßige Verlaufskontrollen. In diesem Beitrag möchten wir einen aktuellen Überblick über die komplexe medikamentöse Therapie der PAH geben.
Abstract
Pulmonary hypertension (PH) is a chronic progressive disease of the pulmonary circulation of multifactorial causes. The current diagnostic classification of PH distinguishes five main groups, which have as a common feature an increased pulmonary arterial pressure and pulmonary resistance. The classification differentiates pulmonary arterial hypertension (PAH), PH due to left heart disease, PH in lung diseases and/or hypoxia, chronic thromboembolic pulmonary hypertension (CTEPH), and PH with unclear/multifactorial mechanisms. Recent advances in basic research with the approval of new drugs and the establishment of therapeutic strategies, mainly in PAH and CTEPH, require a differentiated view of the disease, a careful diagnosis and initiation of therapy, and regular follow-ups. In this article, we provide an overview of the complex drug therapy currently available for PAH patients.
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Interessenkonflikt. M.J. Richter erhielt Vortragshonorare von United Therapeutics/OMT sowie Fortbildungsunterstützung von Bayer. H. Gall erhält finanzielle Unterstützung für seine Forschung und/oder Honorare von Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Janssen-Cilag, Lilly, Pfizer und United Therapeutics/OMT. K. Tello erhielt Vortragshonorare und Fortbildungsunterstützung von Actelion sowie Fortbildungsunterstützung von Bayer. N. Sommer erhielt Vortragshonorare von Actelion und Bayer. F. Grimminger und W. Seeger erhielten Vortragshonorare von Pfizer und Bayer und sind als Berater für Bayer tätig. H.A. Ghofrani erhielt Vortragshonorare von Actelion, Bayer, Ergonex, Gilead, GSK, Novartis und Pfizer, erhält Forschungsförderungen von Actelion, Bayer, Ergonex und Pfizer, ist Gremienmitglied bei Actelion, Bayer, Ergonex, GSK, Novartis, Pfizer und ist als Berater für Actelion, Bayer, Ergonex, Gilead, GSK, Merck, Novartis und Pfizer tätig.
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Richter, M., Gall, H., Tello, K. et al. Medikamentöse Therapie der pulmonalen Hypertonie. Internist 56, 573–582 (2015). https://doi.org/10.1007/s00108-015-3693-0
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DOI: https://doi.org/10.1007/s00108-015-3693-0
Schlüsselwörter
- Pulmonale Hypertonie
- Prostanoide
- Endothelinrezeptorantagonisten
- Phosphodiesterase-5-Hemmer
- Stimulatoren der löslichen Guanylatcyclase