title: Efficacy of acute inhalation of nitric oxide in patients with primary pulmonary hypertension using chronic use of continuous epoprostenol infusion.
abstract: BACKGROUND
  There have only been a few reports published on combination therapy for patients with primary pulmonary hypertension (PPH).
  
  
  RESULTS
  Fifteen patients with PPH (4 men and 11 women, 34.5+/-12.1 years old) had received chronic administration of epoprostenol and the additive effects of inhaled nitric oxide (NO) and the hemodynamic changes were evaluated. In addition, the difference in the effect of acute NO loading before and after the epoprostenol therapy was compared in 6 of these patients. Under chronic use of epoprostenol, mean pulmonary arterial pressure, mean right atrial pressure and pulmonary vascular resistance were decreased with acute inhalation of NO. However, cardiac output, mean aortic pressure and systemic vascular resistance were unchanged. As a result, the pulmonary to systemic vascular resistance ratio was reduced. Moreover, after chronic use of epoprostenol, the change (delta) in cardiac output with NO inhalation was increased and the NO-induced decrease in pulmonary vascular resistance was augmented compared to those before the induction.
  
  
  CONCLUSIONS
  Nitric oxide inhalation further improved the hemodynamics when combined with chronic use of epoprostenol in PPH patients. These results suggest the possibility that combination therapies can be used in the treatment for PPH patients.
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduated School of Medicine, Sendai, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Saji
authors.forename: Masahito
authors.initials: M
authors.lastname: Sakuma
authors.forename: Jun
authors.initials: J
authors.lastname: Suzuki
authors.forename: Tohru
authors.initials: T
authors.lastname: Takahashi
authors.forename: Jun
authors.initials: J
authors.lastname: Demachi
authors.forename: Jun
authors.initials: J
authors.lastname: Nawata
authors.forename: Osamu
authors.initials: O
authors.lastname: Kitamukai
authors.forename: Noriko
authors.initials: N
authors.lastname: Onoue
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Sugimura
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tada
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Fukui
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kagaya
authors.forename: Jun
authors.initials: J
authors.lastname: Watanabe
authors.forename: Kunio
authors.initials: K
authors.lastname: Shirato
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000792:Angiography; D001794:Blood Pressure; D002302:Cardiac Output; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D016896:Treatment Outcome; D014655:Vascular Resistance; D014664:Vasodilation
chemical_list: D009569:Nitric Oxide; D011464:Epoprostenol