title: Additional effects of bosentan in patients with idiopathic pulmonary arterial hypertension already treated with high-dose epoprostenol.
abstract: BACKGROUND
  Combination therapy has been proposed in treatment algorithms for idiopathic pulmonary arterial hypertension (IPAH), so the additional effects of bosentan in IPAH patients already treated with high-dose epoprostenol (EPO) was evaluated in the present study.
  
  
  RESULTS
  Bosentan (62.5 mg twice daily) was administered to 8 IPAH patients already being treated with high-dose EPO (average dose 99.6+/-43.4 ng . kg(-1) . min(-1)). Hemodynamics were assessed at baseline and at 2 days and then 1 year after the initiation of bosentan. Because a remarkable elevation of mixed venous oxygen saturation was observed at the initiation of bosentan, the dosage of EPO was reduced in 7 patients (from 99.6+/-43.4 to 82.8+/-31.3 ng . kg(-1) . min(-1), p<0.05). There was a significant decrease from the baseline value for systolic pulmonary artery pressure (80.1+/-19.3 to 66.8+/-16.5 mmHg, p<0.05). These effects were maintained for 1 year without progression of PAH in 6 patients whose condition had been stabilized at baseline.
  
  
  CONCLUSIONS
  The additional use of bosentan for IPAH patients whose condition has been stabilized by high-dose EPO is safe and effective.
authors.affiliation: Division of Cardiology, National Hospital Organization, Okayama Medical Center, 1711-1 Tamasu, Okayama 701-1192, Japan. satoshi.akagi@gmail.com
authors.forename: Satoshi
authors.initials: S
authors.lastname: Akagi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Matsubara
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Miyaji
authors.forename: Etsuko
authors.initials: E
authors.lastname: Ikeda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Dan
authors.forename: Naoto
authors.initials: N
authors.lastname: Tokunaga
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hisamatsu
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munemasa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohe
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000077300:Bosentan; D002648:Child; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013449:Sulfonamides / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D013449:Sulfonamides; D011464:Epoprostenol; D000077300:Bosentan