Recent advances in the treatment of pulmonary hypertension

Pulmonary hypertension is a debilitating life-threatening disease of all ages. The long-term prognosis can be dismal despite maximal medical therapy. There have been significant advances in our understanding of the pathobiology and genetics of this disease, and novel pharmacological approaches appear to offer promising alternatives to conventional therapy. Anesthesiologists have been instrumental in the development and widespread clinical introduction of inhaled nitric oxide. Unfortunately, despite early optimism, inhaled nitric oxide has several significant limitations related to its cost, toxicity, required complex technology, and occasional therapeutic failure. Therefore, there is a need for an effective alternative pulmonary vasodilator. The early diagnosis and treatment of pulmonary hypertension are crucial if improvements are to be realized. This review will present recent work in this field in an attempt to increase anesthesiologists' awareness of potential new treatment options.

Emerging data concerning the genetics of certain pulmonary hypertension variants have provided insight into the pathobiology of this disease and may lead to advances in the early detection or new treatment options. New pharmacological approaches include drugs such as nitric oxide donors, phosphodiesterase inhibitors, endothelin antagonists, and prostacyclin analogues. Attention has also been focused on the use of combinations of drugs of different classes.

The clinical outcome of pulmonary hypertension is dependent upon early detection and therapy. Increased awareness of current therapeutic options will facilitate earlier effective treatment.