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Treatment of pulmonary hypertension with left heart disease: a concise review

Authors Desai A, Desouza SA

Received 28 April 2016

Accepted for publication 2 December 2016

Published 6 November 2017 Volume 2017:13 Pages 415—420

DOI https://doi.org/10.2147/VHRM.S111597

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Daniel Duprez


Anish Desai, Shilpa A Desouza

Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, USA

Abstract: Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥ 25 mmHg, as determined by right heart catheterization. Pulmonary arterial hypertension (PAH) can no longer be considered an orphan disease given the increase in awareness and availability of new drugs. PH carries with it a dismal prognosis and leads to significant morbidity and mortality. Symptoms can range from dyspnea, fatigue and chest pain to right ventricular failure and death. PH is divided into five groups by the World Health Organization (WHO), based on etiology. The most common cause of PH in developed countries is left heart disease (group 2), owing to the epidemic of heart failure (HF). The data regarding prevalence, diagnosis and treatment of patients with group 2 PH is unclear as large, prospective, randomized controlled trials and standardized protocols do not exist. Current guidelines do not support the use of PAH-specific therapy in patients with group 2 PH. Prostacyclins, endothelin receptor antagonists, phosphodiesterase-5 inhibitors and guanylate cyclase stimulators have been tried in treatment of patients with HF and/or group 2 PH with mixed results. This review summarizes and critically appraises the evidence for diagnosis and treatment of patients with group 2 PH/HF and suggests directions for future research.

Keywords: pulmonary hypertension, left heart disease, diagnosis, treatment
 

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