Treatment strategies in pht
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Transcript of Treatment strategies in pht
Pulmonary arterial hypertension is a disease of the small pulmonary arteries that is characterized by vascular proliferation and remodeling. It results in a progressive increase in pulmonary vascular resistance and, ultimately, right ventricular failure and death.
The complex pathogenesis of this disease and the late diagnosis due to the nonspecific presentation make its treatment to be a difficult task
However, the recent understanding of the pathogenesis of PHT leads to the addition of many new drugs for its treatment
Introduction
Group Drugs
Prostenoids PG I2
agonist
Epoprostenol IV
Trepostinil IV/SC/Inh./oral
Ilioprost Inh.
Enodthelin antagonist Bosentan
Ambresentan
Macitentan
NO Pathway PDE5 Sildenafil, Tadalafil
NO Inhalation
Riociguat
Investgational drugs Selexipag
Imatinib and nilotinib
Current therapies of PHT
Benefit
Increased efficacy
Decrease side effects by use of smaller doses
Simplicity by shifting from IV to oral therapy
The 3 drug groups had been combined as add on
therapy in many clinical trials with good results
though sometimes conflicting
The role of combinations though stressed on in the
guidelines for severe cases need further more data to
confirm its benefit
Combination therapy
Lack of survival benefit
Cost of therapy
Treatment failure
Drug interactions
Toxicity and side effects
Limitations of therapy
Atrial septostomy
Pulmonary artery denervation
VAD
Stem cell therapy
Lung transplantation
Lung heart transplantation
Interventional therapy
Pulmonary HTN is one of the difficult therapeutic problem in CV medicine
The recent understanding of the complicated pathophysiology of the disease has added many new drugs
The starting basic treatment with CCB, Diuretics is used in early low risk cases
Shift to the FDA approved drugs ( prostenoid, ERA, NO pathway active) in severe and high risk patients
Combinations therapy may be used in severe , non-responsive and progressive cases
Interventional therapy is last therapeutic option
Take home message