Effect of inhaled iloprost plus oral sildenafil in patients with primary pulmonary hypertension

被引:296
作者
Wilkens, H [1 ]
Guth, A
König, J
Forestier, N
Cremers, B
Hennen, B
Böhm, M
Sybrecht, GW
机构
[1] Univ Kliniken Saarlandes, Med Klin & Poliklin, D-66421 Homburg, Germany
[2] Univ Kliniken Saarlandes, Inst Med Biometrie Epidemiol & Med Informat, D-66421 Homburg, Germany
关键词
hypertension; pulmonary; iloprost; sildenafil;
D O I
10.1161/hc3601.096826
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The application of iloprost, a stable prostacyclin analogue, by inhalation has been shown to improve hemodynamic variables in patients with primary pulmonary hypertension. However, repetitive inhalations are required due to its short-term effects. One potential approach to prolong and increase the vasorelaxant effects of aerosolized iloprost might be to combine use with phosphodiesterase inhibitors. Methods and Results-The short-term effects of 8.4 to 10.5 mug of aerosolized iloprost, the phosphodiesterase type 5 inhibitor sildenafil, and the combination thereof were compared in 5 patients with primary pulmonary hypertension. Aerosolized iloprost resulted in a more pronounced decrease in mean pulmonary arterial pressure (PAP) than sildenafil alone (9.4+/-1.3 versus 6.4+/-1.1 min Hg; P<0.05). The reduction in mean PAP after sildenafil was maximal after the first dose (25 mg). The combination of sildenafil plus iloprost lowered mean PAP significantly more than iloprost alone (13.8+/-1.4 versus 9.4+/-1.3 = mm Hg; P<0.009). No significant changes in heart rate or systemic arterial pressure were observed during any treatment. The treatments were well tolerated, without major adverse effects. Conclusions-Sildenafil caused a long-lasting reduction in mean PAP and pulmonary vascular resistance, with a further additional improvement after iloprost inhalation. These data suggest that small doses of a phosphodiesterase type 5 inhibitor may be a useful adjunct to inhaled iloprost in the management of pulmonary hypertension.
引用
收藏
页码:1218 / 1222
页数:5
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