title: The response to inhaled nitric oxide in patients with pulmonary artery hypertension is not masked by baseline vasodilator use.
abstract: BACKGROUND
  Assessment of pulmonary vasodilator responsiveness is important in determining the prognosis and management of patients with pulmonary hypertension. Many patients, however, are already on vasodilators at the time of testing. It is unclear if these agents should be temporarily discontinued to improve the sensitivity of testing.
  
  
  METHODS
  We examined the hemodynamic effects of nitric oxide (NO) inhalation in 60 patients with pulmonary arterial hypertension. Thirty-one of these patients were receiving medications with vasodilating properties. Vasodilator testing was performed with invasive measurement of pressure of the right side of the heart at baseline and during inhalation of 40 ppm NO.
  
  
  RESULTS
  No significant demographic differences were seen between patients receiving and not receiving vasodilators. Similar reductions in mean pulmonary artery pressure (19 +/- 12% vs 20 +/- 12%, P = .734) and pulmonary vascular resistance (31 +/- 18 vs 32 +/- 16, P = .967) were seen in patients receiving and not receiving vasodilators. Using the definition of positive vasodilator response (> or = 20% drop in mean pulmonary artery pressure), 55% (17/31) of patients in the baseline vasodilator group had a positive response compared with 62% (18/29) of the patients not on vasodilators (P = .570).
  
  
  CONCLUSIONS
  Concurrent use of oral vasodilators does not appear to mask a significant response to inhaled NO on the pulmonary vasculature. Therefore, routine discontinuation of pulmonary vasodilators is likely unnecessary before vasodilator testing in patients with pulmonary arterial hypertension.
authors.affiliation: Division of Cardiology, Wilford Hall Medical Center, Lackland AFB, TX 78236-5300, USA. richard.krasuski@lackland.af.mil
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Bashore
mesh_terms: D000280:Administration, Inhalation; D001794:Blood Pressure; D004347:Drug Interactions; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide