肺动脉高压药物治疗左心继发性肺动脉高压患者的疗效和安全性:系统综述

K. Kido, James C. Coons
{"title":"肺动脉高压药物治疗左心继发性肺动脉高压患者的疗效和安全性:系统综述","authors":"K. Kido, James C. Coons","doi":"10.1002/phar.2314","DOIUrl":null,"url":null,"abstract":"Pulmonary hypertension (PH) is often caused by left heart disease (LHD) such as heart failure (HF) or valvular heart disease. Historically, few randomized controlled trials have evaluated the off‐label use of medications for treating pulmonary arterial hypertension (PAH) in patients with PH‐LHD. However, multiple randomized controlled trials have been published over the last decade that investigated their use in patients with PH‐LHD. In addition, recent updates in the classification and definitions of PH have led to an improved recognition of PH‐LHD phenotypes, notably combined post‐capillary and pre‐capillary PH and isolated post‐capillary PH. In this systematic review, we show that PAH medications should not be recommended in two distinct HF populations: patients with HF without definitive PH diagnosis and patients with isolated post‐capillary PH due to HF. In addition, the use of bosentan or macitentan is not recommended in patients with combined post‐capillary and pre‐capillary PH due to HF, but sildenafil may be considered to improve pulmonary hemodynamics and exercise capacity in patients with combined post‐capillary and pre‐capillary PH due to HF. Riociguat 2 mg 3 times daily may also be considered to improve pulmonary hemodynamics in patients with combined post‐capillary and pre‐capillary PH due to heart failure with reduced ejection fraction but not heart failure with preserved ejection fraction. The postoperative use of sildenafil in the setting of PH after valvular heart disease intervention was evaluated. Limited clinical data and safety concern warrants caution with the postoperative use of sildenafil in patients with PH due to valvular heart disease. Despite recent advances in the understanding of PAH medications for patients with PH‐LHD, uncertainty remains about their utility in distinct subgroups. Nonetheless, PAH pharmacotherapy should generally be avoided for most patients with PH‐LHD.","PeriodicalId":19812,"journal":{"name":"Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"9","resultStr":"{\"title\":\"Efficacy and Safety of the Use of Pulmonary Arterial Hypertension Pharmacotherapy in Patients with Pulmonary Hypertension Secondary to Left Heart Disease: A Systematic Review\",\"authors\":\"K. Kido, James C. Coons\",\"doi\":\"10.1002/phar.2314\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Pulmonary hypertension (PH) is often caused by left heart disease (LHD) such as heart failure (HF) or valvular heart disease. Historically, few randomized controlled trials have evaluated the off‐label use of medications for treating pulmonary arterial hypertension (PAH) in patients with PH‐LHD. However, multiple randomized controlled trials have been published over the last decade that investigated their use in patients with PH‐LHD. In addition, recent updates in the classification and definitions of PH have led to an improved recognition of PH‐LHD phenotypes, notably combined post‐capillary and pre‐capillary PH and isolated post‐capillary PH. In this systematic review, we show that PAH medications should not be recommended in two distinct HF populations: patients with HF without definitive PH diagnosis and patients with isolated post‐capillary PH due to HF. In addition, the use of bosentan or macitentan is not recommended in patients with combined post‐capillary and pre‐capillary PH due to HF, but sildenafil may be considered to improve pulmonary hemodynamics and exercise capacity in patients with combined post‐capillary and pre‐capillary PH due to HF. Riociguat 2 mg 3 times daily may also be considered to improve pulmonary hemodynamics in patients with combined post‐capillary and pre‐capillary PH due to heart failure with reduced ejection fraction but not heart failure with preserved ejection fraction. The postoperative use of sildenafil in the setting of PH after valvular heart disease intervention was evaluated. Limited clinical data and safety concern warrants caution with the postoperative use of sildenafil in patients with PH due to valvular heart disease. Despite recent advances in the understanding of PAH medications for patients with PH‐LHD, uncertainty remains about their utility in distinct subgroups. Nonetheless, PAH pharmacotherapy should generally be avoided for most patients with PH‐LHD.\",\"PeriodicalId\":19812,\"journal\":{\"name\":\"Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"9\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/phar.2314\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/phar.2314","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 9

摘要

肺动脉高压(PH)通常由左心疾病(LHD)引起,如心力衰竭(HF)或瓣膜性心脏病。从历史上看,很少有随机对照试验评估药物治疗PH‐LHD患者肺动脉高压(PAH)的说明书外使用情况。然而,在过去的十年中,已经发表了多个随机对照试验,研究了它们在PH‐LHD患者中的应用。此外,最近对PH的分类和定义进行了更新,从而提高了对PH - LHD表型的认识,特别是结合了毛细管后和毛细管前PH以及分离的毛细管后PH。在这篇系统综述中,我们表明在两种不同的HF人群中不应推荐PAH药物:没有明确PH诊断的HF患者和由于HF而分离的毛细管后PH患者。此外,对于心力衰竭并发毛细血管后和毛细血管前联合PH的患者,不推荐使用波生坦或马西坦,但对于心力衰竭并发毛细血管后和毛细血管前联合PH的患者,西地那非可能被认为可以改善肺血流动力学和运动能力。对于因心力衰竭伴射血分数降低而非伴射血分数保留的心力衰竭而合并毛细血管后和毛细血管前PH值的患者,瑞西瓜特2 mg每日3次也可被认为改善肺血流动力学。评价瓣膜性心脏病干预后西地那非在PH设置中的术后应用。有限的临床数据和对安全性的考虑使得西地那非在瓣膜性心脏病引起的PH患者术后使用更加谨慎。尽管最近对PH‐LHD患者的多环芳烃药物的了解有所进展,但它们在不同亚组中的效用仍然不确定。尽管如此,对于大多数PH‐LHD患者,PAH药物治疗通常应该避免。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and Safety of the Use of Pulmonary Arterial Hypertension Pharmacotherapy in Patients with Pulmonary Hypertension Secondary to Left Heart Disease: A Systematic Review
Pulmonary hypertension (PH) is often caused by left heart disease (LHD) such as heart failure (HF) or valvular heart disease. Historically, few randomized controlled trials have evaluated the off‐label use of medications for treating pulmonary arterial hypertension (PAH) in patients with PH‐LHD. However, multiple randomized controlled trials have been published over the last decade that investigated their use in patients with PH‐LHD. In addition, recent updates in the classification and definitions of PH have led to an improved recognition of PH‐LHD phenotypes, notably combined post‐capillary and pre‐capillary PH and isolated post‐capillary PH. In this systematic review, we show that PAH medications should not be recommended in two distinct HF populations: patients with HF without definitive PH diagnosis and patients with isolated post‐capillary PH due to HF. In addition, the use of bosentan or macitentan is not recommended in patients with combined post‐capillary and pre‐capillary PH due to HF, but sildenafil may be considered to improve pulmonary hemodynamics and exercise capacity in patients with combined post‐capillary and pre‐capillary PH due to HF. Riociguat 2 mg 3 times daily may also be considered to improve pulmonary hemodynamics in patients with combined post‐capillary and pre‐capillary PH due to heart failure with reduced ejection fraction but not heart failure with preserved ejection fraction. The postoperative use of sildenafil in the setting of PH after valvular heart disease intervention was evaluated. Limited clinical data and safety concern warrants caution with the postoperative use of sildenafil in patients with PH due to valvular heart disease. Despite recent advances in the understanding of PAH medications for patients with PH‐LHD, uncertainty remains about their utility in distinct subgroups. Nonetheless, PAH pharmacotherapy should generally be avoided for most patients with PH‐LHD.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信