Pulmonary hypertension refers to a condition with increased pulmonary artery pressure. The pulmonary artery carries blood from the right upper chamber of the heart to the lungs for oxygenation. The pressure in this artery is usually low. An increase causes the arteries to narrow, leading to pulmonary hypertension, which subsequently reduces blood oxygenation. Since the symptoms of pulmonary hypertension are similar to other heart and lung conditions, it is usually hard to diagnose. The symptoms can be managed well with certain inhaled medicines and other therapies. In this article, we’ll explore the different forms of pulmonary hypertension treatment.
Treatment of Pulmonary Hypertension
The following options are recommended for pulmonary hypertension treatment:
1. Medicines – Various medicines are available for symptomatic relief from pulmonary hypertension, which can be categorised as follows:
- Calcium channel blockers or CCBs – They are used as first-line pulmonary hypertension treatment in many cases. Depending upon the symptoms and severity, different CCBs are recommended. Some common CCBs are Amlodipine, Nifedipine, Diltiazem, and more.
- Phosphodiesterase type 5 inhibitors or PDE-5i and soluble Guanylate cyclase stimulators or sGCS – These are nitric oxide (NO) pathway modulators and work by increasing NO levels that consequently causes vasodilation (expanding blood vessels and reducing pressure).
- Endothelin receptor antagonists or ERAs - Endothelin -1 receptor A is known to cause vasoconstriction (narrowing of blood vessels). Blocking endothelin A receptors thus gives symptomatic relief to pulmonary hypertension patients. One example of an endothelin receptor type A antagonist is Ambrisentan, which is recommended for pulmonary hypertension patients.
- Prostacyclin analogs (PCA) and prostacyclin receptor agonists or PRA – Pulmonary hypertension patients exhibit deregulation of a process called the prostacyclin pathway which further causes platelet aggregation and blood thickening. So, medicines targeting this pathway and acting as blood thinners are recommended for pulmonary hypertension. Examples of such medicines are Epoprostenol, Treprostinil, and Iloprost. Another blood thinner often recommended is warfarin.
- Other medicines – Some medicines that impact cardiac arrhythmia are also recommended to regulate the heartbeat. Diuretics or water pills are usually given, as the kidney works well to remove excess fluid, and the consequent pressure build-up is low, resulting in lower stress on the heart.
2. Oxygen Therapy – This therapy aims to provide extra supplemental oxygen to breathe. This helps the idiopathic pulmonary hypertension patients in particular, allowing for easier breathing.
3. Surgery – This is done when the medicinal treatment does not provide a good outcome. It includes:
- Interventional Therapy: Therapies like balloon atrial septostomy and Potts shunt are used to relax the right upper chamber of the heart and to improve systemic blood flow.
- Lung and Heart-Lung Transplantation: This is done only in case the other therapies fail. It is recommended in patients with diseases such as pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis.