title: Pulmonary arterial hypertension:  classification and therapy with a focus on prostaglandin analogs.
abstract: Pulmonary arterial hypertension, part of the larger spectrum of disorders causing pulmonary hypertension, is a complex and progressive disease of multiple etiologies that ultimately leads to vascular remodeling, right-sided heart failure, and death. Advances in treatment over the past 15 to 20 years have dramatically reduced the morbidity and mortality of the disease, but often have significant drawbacks. Of the more recently approved therapies, the prostaglandin analogs have been shown to have the greatest therapeutic benefit but are also the most difficult to administer, many being given as continuous intravenous infusions in the ambulatory setting. After a case presentation highlighting some of the challenges that accompany treatment with these agents, this article reviews the diagnosis and classification of pulmonary hypertension and pulmonary arterial hypertension and gives a brief overview of the various other pharmacologic agents used in its treatment. A more comprehensive review of the biochemistry of prostaglandins and the pharmacology and clinical use of this class of drugs follows. Recommended treatment guidelines are also discussed.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL 32610, USA. papiee@medicine.ufl.edu
authors.forename: Eric S
authors.initials: ES
authors.lastname: Papierniak
authors.forename: David T
authors.initials: DT
authors.lastname: Lowenthal
authors.forename: Kamal
authors.initials: K
authors.lastname: Mubarak
mesh_terms: D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011464:Epoprostenol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D007262:Infusions, Intravenous; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011453:Prostaglandins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D011453:Prostaglandins; D011464:Epoprostenol; C427248:treprostinil