This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rich, S. Articles by Levy, P. S. Search for Related Content PubMed PubMed Citation Articles by Rich, S. Articles by Levy, P. S. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB HYDRALAZINE HYDROCHLORIDE Medline Plus Health Information Pulmonary Hypertension

Circulation, Vol 71, 1191-1196, Copyright © 1985 by American Heart Association

ARTICLES

The effect of vasodilator therapy on the clinical outcome of patients with primary pulmonary hypertension

S Rich, BH Brundage and PS Levy

The short- and long-term hemodynamic effects of vasodilators in patients with primary pulmonary hypertension have been studied, but whether they affect survival is unknown. We measured the short-term response to nifedipine and hydralazine in 23 patients with primary pulmonary hypertension and followed their clinical course over 2 years. A favorable drug response, defined as a fall in the pulmonary vascular resistance of 20% or greater, occurred in 18 patients (78%). Half of the patients who exhibited a favorable short-term response were treated with long-term vasodilator therapy. Their clinical course was compared with that of responders who were not treated and with that of the nonresponders. Of the responders who were treated, two improved, four had no change, and three died; of the responders who were not treated, one improved, three had no change, and five died. Using stepwise Cox regression, we evaluated age, sex, functional class on entry, pulmonary arterial pressure, pulmonary vascular resistance, and short-term drug response as predictors of survival and found only functional class and a favorable short-term drug response to be significant predictors (p less than .01); however, there was no difference in survival between the responders who were treated and those who were not. We conclude that the ability to respond to short-term nifedipine or hydralazine therapy predicts longer survival for patients with primary pulmonary hypertension, but placing patients with a favorable short-term response on long-term vasodilator therapy does not affect the overall outcome.

This article has been cited by other articles:

				O. Sitbon, M. Humbert, X. Jais, V. Ioos, A. M. Hamid, S. Provencher, G. Garcia, F. Parent, P. Herve, and G. Simonneau Long-Term Response to Calcium Channel Blockers in Idiopathic Pulmonary Arterial Hypertension Circulation, June 14, 2005; 111(23): 3105 - 3111. [Abstract] [Full Text] [PDF]

				E. Bossone, B. D. Bodini, A. Mazza, and L. Allegra Pulmonary Arterial Hypertension: The Key Role of Echocardiography Chest, May 1, 2005; 127(5): 1836 - 1843. [Abstract] [Full Text] [PDF]

				D. Chemla, V. Castelain, P. Herve, Y. Lecarpentier, and S. Brimioulle Haemodynamic evaluation of pulmonary hypertension Eur. Respir. J., November 1, 2002; 20(5): 1314 - 1331. [Abstract] [Full Text] [PDF]

				E. Bossone, G. Paciocco, D. Iarussi, A. Agretto, A. Iacono, B. W. Gillespie, and M. Rubenfire The Prognostic Role of the ECG in Primary Pulmonary Hypertension Chest, February 1, 2002; 121(2): 513 - 518. [Abstract] [Full Text] [PDF]

				H. Ting, X.-G. Sun, M.-L. Chuang, D. A. Lewis, J. E. Hansen, and K. Wasserman A Noninvasive Assessment of Pulmonary Perfusion Abnormality in Patients With Primary Pulmonary Hypertension Chest, March 1, 2001; 119(3): 824 - 832. [Abstract] [Full Text] [PDF]

				S. Kesten, J. Dainauskas, V. McLaughlin, and S. Rich Development of Nonspecific Interstitial Pneumonitis Associated With Long-term Treatment of Primary Pulmonary Hypertension With Prostacyclin Chest, August 1, 1999; 116(2): 566 - 569. [Abstract] [Full Text] [PDF]

				K. OKADA, M. L. BERNSTEIN, W. ZHANG, D. P. SCHUSTER, and M. D. BOTNEY Angiotensin-converting Enzyme Inhibition Delays Pulmonary Vascular Neointimal Formation Am. J. Respir. Crit. Care Med., September 1, 1998; 158(3): 939 - 950. [Abstract] [Full Text] [PDF]

				A. S. Malik, S. Warshafsky, and S. Lehrman Meta-analysis of the Long-term Effect of Nifedipine for Pulmonary Hypertension Arch Intern Med, March 24, 1997; 157(6): 621 - 625. [Abstract] [PDF]

				O. Raffy, R. Azarian, F. Brenot, F. Parent, O. Sitbon, P. Petitpretz, P. Herve, P. Duroux, A. T. Dinh-Xuan, and G. Simonneau Clinical Significance of the Pulmonary Vasodilator Response During Short-term Infusion of Prostacyclin in Primary Pulmonary Hypertension Circulation, February 1, 1996; 93(3): 484 - 488. [Abstract] [Full Text]

				M. A. Alpert, M. D. Concannon, B. Mukerji, and V. Mukerji Pharmacotherapy of Chronic Pulmonary Arterial Hypertension: Value and Limitations: Part I: Primary Pulmonary Hypertension Angiology, August 1, 1994; 45(8): 667 - 676. [Abstract] [PDF]

				H. I. Palevsky and A. P. Fishman The Management of Primary Pulmonary Hypertension JAMA, February 27, 1991; 265(8): 1014 - 1020. [Abstract] [PDF]

				S. RICH, S. LEVITSKY, and B. H. BRUNDAGE Pulmonary Hypertension from Chronic Pulmonary Thromboembolism Ann Intern Med, March 1, 1988; 108(3): 425 - 434. [Abstract] [PDF]

				Drugs Five Years Later: Nifedipine in Myocardial Ischemia, Systemic Hypertension, and Other Cardiovascular Disorders Ann Intern Med, November 1, 1986; 105(5): 714 - 729. [Abstract] [PDF]

				S. RICH, G. G. PIETRA, K. KIERAS, K. HART, and B. H. BRUNDAGE Primary Pulmonary Hypertension: Radiographic and Scintigraphic Patterns of Histologic Subtypes Ann Intern Med, October 1, 1986; 105(4): 499 - 502. [Abstract] [PDF]