Efficacy of acute inhalation of nitric oxide in patients with primary pulmonary hypertension using chronic use of continuous epoprostenol infusion.
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.
Saji
Kenya
K
Department of Cardiovascular Medicine, Tohoku University Graduated School of Medicine, Sendai, Japan.
Sakuma
Masahito
M
Suzuki
Jun
J
Takahashi
Tohru
T
Demachi
Jun
J
Nawata
Jun
J
Kitamukai
Osamu
O
Onoue
Noriko
N
Sugimura
Kouichiro
K
Tada
Tomohiro
T
Fukui
Shigefumi
S
Kagaya
Yutaka
Y
Watanabe
Jun
J
Shirato
Kunio
K
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
D009569:Nitric Oxide; D011464:Epoprostenol