Recent Trends in the Management of Pulmonary Hypertension

Context. Pulmonary hypertension is a common clinical problem encountered in day-to-day practice. Drug therapy forms the backbone of management and appropriate drug selection is based upon the underlying causes. The options available are widening with availability of newer therapeutic agents and thus it becomes necessary to be updated with the recent developments. Objective. To review the existing data regarding the efficacy, tolerability and superiority of current drug options for pulmonary hypertension on the basis of the existing data and to provide an approach to manage a patient with pulmonary hypertension. Data Sources. A thorough search of the MICROMEDEX database, updated version of June 2004 was performed. The search also included the Iowa Drug Information System (IDIS), updated version of September 2003 search for relevant trials. Additional trials from MEDSCAPE were also included. A manual search of journals was also performed for indigenous studies done on the related area. Study Selection and Data Extraction. Search terms included pulmonary hypertension, newer drugs for pulmonary hypertension, secondary pulmonary hypertension and specific drug category. Studies were selected if efficacy, tolerability and superiority were reported as major outcome measures. The preference was given for the studies, which compared the superiority of drug(s) with that of other ones either with in, or different categories. Data Synthesis. Five categories of drugs were located with the exception of the miscellaneous ones. Each category had its own merits and demerits. Only prostaglandin analogs are available in the oral form and offers patient friendliness. There were no large randomized trials comparing the effects of these agents in large patient population. There were no placebo-controlled trials prior to 1999. There are few studies evaluating the long-term efficacy of the drugs mentioned so far and their effects on survival. However, these drugs appear promising. Conclusions. The current options for the drug therapy of pulmonary hypertension are increasing and the newer drugs show promising effects in the management of pulmonary hypertension.