Correlation of Acute Prostacyclin Response in Primary (Unexplained) Pulmonary Hypertension with Efficacy of Treatment with Calcium Channel Blockers and Survival

  • Bertron M. Groves
  • David B. Badesch
  • Darya Turkevich
  • Roy V. Ditchey
  • Kathleen Donnellan
  • Kristine Wynne
  • Alastair D. Robertson
  • Walker A. Long
  • Norbert Voelkel
  • John T. Reeves
Part of the NATO ASI Series book series (NSSA, volume 251)

Abstract

Unexplained, or primary, pulmonary hypertension, is usually a rapidly fatal disease, in which the use of vasodilator therapy is controversial (14, 22, 25). While some authors have proposed that there may be a significant vasoconstrictive component to the increased pulmonary arterial pressure and resistance (2, 7, 11, 19), others have indicated that such a component is usually small and/or unimportant (13). This controversy has likely arisen because the disease is relatively uncommon, its pathogenesis is not understood, it is usually diagnosed late in the natural history, and the rate of progression is variable between patients. Yet investigation into the problem is important because persons afflicted are often young and otherwise healthy. Needed was a prospective, longitudinal study in a relatively large group of patients, where the magnitude of the vasoconstrictive component could be measured acutely and compared to results of long term treatment.

Keywords

Catheter Titration Cardiol Nifedipine Kelly 

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References

  1. 1.
    Anderson, E. G., G. Simon, and L. Reid. Primary and thromboembolic pulmonary hypertension: a quantitative pathological study. J. Pathol. 110: 273–293, 1973.CrossRefGoogle Scholar
  2. 2.
    Daoud, F.S., D.B. Kelly, and J.T. Reeves. Isoproteronol as a potential pulmonary vasodilator in primary pulmonary hypertension. Am. J. Cardiol. 42: 817–823, 1978.PubMedCrossRefGoogle Scholar
  3. 3.
    D’Alonzo, G.E., R.J. Barst, S.M. Ayers, E.H. Bergofsky, B.H. Brundage, K.M. Detre, A.P. Fishman, R.M. Goldring, B.M. Groves, J.T. Kernis, P.S. Levy, G.G. Pietra, L.M. Reid, J.T. Reeves, S. Rich, C.E. Vreim, G.W. Williams, and M. Wu. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann. Intern. Med. 115: 343–349, 1991.Google Scholar
  4. 4.
    Groves, B.M., R.V. Ditchey, J.T. Reeves, B.H. Brundage, CR. McKay, E. Powers, R. Barst, L.J. Rubin, L.J. Aker, R. Siegel, and H. Zadaca. Multicenter trial of a new guidewire thermodilution catheter. J. Am. Coll. Cardiol. 3: 599, 1984.Google Scholar
  5. 5.
    Groves, B.M., K. Donnellan, A.D. Robertson, and J.T. Reeves. Diltiazem inhibits hypoxic pulmonary vasoconstriction in primary pulmonary hypertension. In: Sutton, J.R., Coates, G, and Remmers, J.E. eds., Hypoxia: The adaptations, pages 163-169, Toronto, B.C. Decker, Inc., 1990.Google Scholar
  6. 6.
    Groves, B.M., Rubin, L.J., Frosolono, M.F., and J.T. Reeves. A comparison of the hemodynamic effects of prostacyclin and hydralazine in primary pulmonary hypertension. Am. Heart J. 110: 1200–1204, 1985.PubMedCrossRefGoogle Scholar
  7. 7.
    Groves, B.M., Turkevich, D., Donnellan, K., Voelkel, N., Robertson, A.D., and Reeves, J.T. Current approach to treatment of primary pulmonary hypertension. Chest 93: 175S–178S, 1988.PubMedGoogle Scholar
  8. 8.
    Higenbottam, T. The place of prostacyclin in the clinical management of primary pulmonary hypertension. Am. Rev. Resp. Dis. 136: 782–785, 1987.PubMedCrossRefGoogle Scholar
  9. 9.
    Jones, D.K., T.W. Higenbottam, and J. Wallwork. Treatment of primary pulmonary hypertension with intravenous epoprostenol (prostacyclin). Br. Heart J. 57: 270–278, 1987.PubMedCrossRefGoogle Scholar
  10. 10.
    Kambara, H., K. Fujimoto, A. Wakabayashi, and C. Kawai. Primary pulmonary hypertension: beneficial therapy with diltiazem. Am. Heart J. 101: 21–23, 1981.CrossRefGoogle Scholar
  11. 11.
    Lupi-Herrera, E., Sandoval, J. Seoane, M., andD. Bialostozky. The role of hydralazaine therapy for pulmonary arterial hypertension of unknown cause. Circulation 65: 645–650, 1982.PubMedCrossRefGoogle Scholar
  12. 12.
    Mc Murtry, IF., Davidson, A.B., Reeves, J.T., and R.F. Grover. Inhibition of hypoxic pulmonary vasoconstriction by calcium antagonists in isolated rat lungs. Circ. Res. 38: 99–104, 1976.CrossRefGoogle Scholar
  13. 13.
    Packer, M. Greenberg, B., Massie, B., and H. Dash. Deleterious effects of hydralazine in patients with pulmonary hypertension. N. Engl. J. Med. 306: 1326–1331, 1982.PubMedCrossRefGoogle Scholar
  14. 14.
    Reeves, J. T., B.M. Groves, and D. Turkevich. The case for treatment of selected patients with primary pulmonary hypertension. Am. Rev. Resp. Dis. 134: 342–346, 1986.PubMedGoogle Scholar
  15. 15.
    Reeves, J.T., and J.A. Noonan. Microarteriographic studies of primary pulmonary hypertension. Arch. Pathol. 95: 50–55, 1973.PubMedGoogle Scholar
  16. 16.
    Rich, S., and B.H. Brundage. High-dose calcium channel-blocking therapy for primary pulmonary hypertension: evidence for long-term reduction in pulmonary arterial pressure and regression of right ventricular hypertrophy. Circulation 16: 135–141, 1987.CrossRefGoogle Scholar
  17. 17.
    Rich, S., and E. Kaufmann. High dose titration of calcium channel blocking agents for primary pulmonary hypertension: guidelines for short-term drug testing. J. Am. Coll. Cardiol. 18: 1323–1327, 1991.PubMedCrossRefGoogle Scholar
  18. 18.
    Rich, S., E. Kaufmann, and P.S. Levy. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N. Engl. J. Med. 327: 76–81, 1992.PubMedCrossRefGoogle Scholar
  19. 19.
    Rubin, L.J. and R.H. Peter. Oral hydralazine therapy for primary pulmonary hypertension. N. Engl J. Med. 302: 69–73, 1980.PubMedCrossRefGoogle Scholar
  20. 20.
    Rubin, L.J., B.M. Groves, J.T. Reeves, M. Frosolono, F. Handel, and A.E. Cato. Prostacyclin induced acute pulmonary vasodilation in pulmonary hypertension. Circulation 66: 334–338, 1982.PubMedCrossRefGoogle Scholar
  21. 21.
    Rubin, L.J., J. Mendoza, M. Hood, M. McGoon, R. Barst, W.B. Williams, J.H. Diehl, J. Crow, and W. Long. Treatment of primary pulmonary hypertension with continuous intravenous prostacyclin (epoprostenol). Results of a randomized trial. Ann. Intern. Med. 112: 485–491, 1990.PubMedGoogle Scholar
  22. 22.
    Voelkel, N.F., and J.T. Reeves. Primary pulmonary hypertension. In: K.M. Moser, ed. Pulmonary Vascular Disease, pp 573–628. New York: Marcel Dekker, 1979.Google Scholar
  23. 23.
    Von Grondelle, A., R.V. Ditchey, B.M. Groves, W.W. Wagner, and J.T. Reeves. Thermodilution method overestimates low cardiac output in humans. Am. J. Physiol. 14: H690–692, 1983.Google Scholar
  24. 24.
    Wagenvoort, C.A., and N. Wagenvoort. Primary pulmonary hypertension. Circulation 42: 1163–1184, 1970.CrossRefGoogle Scholar
  25. 25.
    Weir, E.K. Diagnosis and management of primary pulmonary hypertension. In: Pulmonary Hypertension. E.K. Weir and J.T. Reeves, eds. pp 115–168. Mt. Kisco, NY: Futura, 1984.Google Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Bertron M. Groves
    • 1
    • 2
  • David B. Badesch
    • 1
    • 2
  • Darya Turkevich
    • 1
    • 2
  • Roy V. Ditchey
    • 1
    • 2
  • Kathleen Donnellan
    • 1
    • 2
  • Kristine Wynne
    • 1
    • 2
  • Alastair D. Robertson
    • 1
    • 2
  • Walker A. Long
    • 1
    • 2
  • Norbert Voelkel
    • 1
    • 2
  • John T. Reeves
    • 1
    • 2
  1. 1.Department of Medicine, Divisions of Cardiology and Pulmonary Sciences and the Cardiovascular Pulmonary Research LaboratoryUniversity of Colorado Health Sciences CenterDenverUSA
  2. 2.Burroughs Wellcome Co.USA

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