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Drug-induced pulmonary arterial hypertension: a review

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Abstract

Pulmonary arterial hypertension (PAH) is a subgroup of PH patients characterized hemodynamically by the presence of pre-capillary PH, defined by a pulmonary artery wedge pressure (PAWP) ≤15 mmHg and a PVR >3 Wood units (WU) in the absence of other causes of pre-capillary PH. According to the current classification, PAH can be associated with exposure to certain drugs or toxins such as anorectic agents, amphetamines, or selective serotonin reuptake inhibitors. With the improvement in awareness and recognition of the drug-induced PAH, it allowed the identification of additional drugs associated with an increased risk for the development of PAH. The supposed mechanism is an increase in the serotonin levels or activation of serotonin receptors that has been demonstrated to act as a growth factor for the pulmonary artery smooth muscle cells and cause progressive obliteration of the pulmonary vasculature. PAH remains a rare complication of several drugs, suggesting possible individual susceptibility, and further studies are needed to identify patients at risk of drug-induced PAH.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18109, USA

    Lohit Garg, Ghulam Akbar, Mahek Shah & Brijesh Patel

  2. 1250 S. Cedar Crest Blvd, Suite 305, Allentown, PA, 18103, USA

    Lohit Garg

  3. Department of Cardiovascular Medicine, St. Luke’s University Health Network, Bethlehem, PA, 18015, USA

    Sahil Agrawal

  4. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, 38103, USA

    Manyoo Agarwal

  5. Department of Internal Medicine, Beaumont Health, Royal Oak, MI, 48073, USA

    Leila Khaddour & Bhavinkumar D. Dalal

  6. Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, 48197, USA

    Rishin Handa

  7. Department of Internal Medicine, St. Peter’s University Hospital, New Brunswick, NJ, 08901, USA

    Aakash Garg

  8. Department of Pulmonary Medicine, Beaumont Health, Royal Oak, MI, 48073, USA

    Bhavinkumar D. Dalal

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  1. Lohit Garg
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Garg, L., Akbar, G., Agrawal, S. et al. Drug-induced pulmonary arterial hypertension: a review. Heart Fail Rev 22, 289–297 (2017). https://doi.org/10.1007/s10741-017-9612-9

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