[Treatment of pulmonary arterial hypertension: prostacyclin analogs]

Prostanoids continue to be of great importance in the treatment of pulmonary hypertension (PHT). Their vasodilatory, antiproliferative, anti-inflammatory and anticoagulant profile of effects makes them suitable substances in the treatment of PHT whose pathogenesis, vasoconstriction, proliferation, vascular modelling and in-situ thromboses play a role. Current tendency is to use other oral drugs as primary and initial treatment. But it is important not to miss the point when prostanoids are required as additional or alternative treatment. Prostanoids are indicated in current treatment algorithms for patients in NYHA class III or IV, especially those in right ventricular failure. Prostanoids can be given by continual intravenous or subcutaneous infusion, by mouth or as inhalants. Inhalant isoprost is practicable and well tolerated and improves the clinical condition and survival prognosis when given to patients with severe PHT. New developments with prostanoids apply largely to combination treatment.