[Current views on the use of vasodilators in pulmonary hypertension]

Vasodilators represent one of the main steps for the medical treatment of pulmonary hypertension; the rationale for their use is the reversibility of the pulmonary vasoconstriction, to be tested with a correct pharmacological trial. In this report the authors consider the use of calcium-channel blockers, prostaglandin and nitric oxide. Calcium blockers, the only drugs active when administered orally, provide a satisfactory clinical response in 25-30% of treated patients. Prostaglandins are active in a higher percentage of patients and can be infused in a domiciliary regimen with portable pumps even for long periods of time. Nitric oxide is the only selective pulmonary vasodilator; it is used in paediatric and adult cardiac surgery and in patients affected by respiratory distress syndrome, but its use is restricted to intensive care units and many cautions must be adopted. Finally some future therapeutic strategies are briefly reviewed: endothelin inhibitors, cGMP phosphodiesterase inhibitors etc.