Novel Strategies and Approaches in Hypertension Therapy

Novel Strategies and Approaches in Hypertension Therapy

Current and Future Developments in Hypertension

INTRODUCTION: Hypertension has become a major public health problem in the last few decades. High blood pressure is a serious risk factor for premature cardiovascular disease and end-organ damage ...
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Pulmonary Hypertension

Pp. 124-138 (15)

Pelin Uysal and Hafize Uzun

Abstract

Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition defined as right pulmonary artery pressure (PAP) determined by right heart catheterizatition (RHC) at rest, at 25 mm Hg or higher. RHC and vasoreactivity test are the gold standard methods for diagnosis, treatment and prognosis follow-up of PH. Each group has different physiopathological features. Three main features that outstand in pulmonary artery are vasoconstriction, remodeling of arterial wall and in situ thrombosis. A wide variety of biomarkers have been explored, although there is no specific marker for PH. Patients were stratified according to pathophysiological, hemodynamical features, clinical pictures and form of treatment. Differential diagnosis of PH might be difficult because of its non-specific symptoms and it might be caused by many different disorders. Exertional dyspnea disproportional with underlying cause should be warning. Findings on physical examination are related with underlying disease. Treatment of the underlying disease is important. In patients with positive vasoreactivity test might benefit from calcium channel blockers. In patients with poor prognosis, treatment with a combination protocol involves intravenous (IV) treatment. Many combination treatments are used or developing at the present time. PAH is rare and often diagnosed late. Novel circulating biomarkers could contribute to the screening of PH. Different biomarkers may lead to different relevant information in PH patients, including disease progression, response to medical and surgical therapy, and prognosis. This chapter presents an update on alterations in the diagnostic algorithm, haemodynamic definitions, biomarkers, treatment and prognose in PH. A multiparametric approach is usually preferred because PH is more of a systemic condition than an isolated cardiorespiratory illness.

Keywords:

Pulmonary hypertension, Walking test, Artery pressure, Pulmonary artery, Hypoxia, Vasoconstriction, Remodeling, Arterial wall, Thrombosis, Catheterization, Diagnostic algorithm, Haemodynamic definitions, Venoocclusive disease, Treatment, Prognose, Biomarkers, Serotonin, Endotelin-1, Thromboxane, Natriuretic peptides.

Affiliation:

Department of Medical Biochemistry, Cerrahpaşa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey.