Experience with conventional vasodilator treatment has come mainly from the therapy of severe and moderate pulmonary hypertension. However, there are only few selective vasodilators currently available. In fact, even at present, inhaled oxygen cannot be administered to patients for more than three months due to several toxicologic considerations. The most effective treatment method for these patients is currently thought to be the use of nebulizer devices.
Pulmonary arterial hypertension occurs when the heart failure is contained in a narrowed blood vessel (vasculitis) located in the lungs. This narrowing causes decreased blood supply, poor delivery of nutrients and waste products, and decreased oxygenation of the arterial walls. There is decreased cardiac output that is often associated with chest pain, shortness of breath, fatigue, headache, nausea, and coughing. These symptoms can be heightened by stress and the common cold. The best treatment for pulmonary arterial hypertension is currently focused on improving the clinical care of patients with this condition, especially as a first line of defense against heart failure.
The disease is a chronic consequence of intrinsic factors, some of which are beyond the control of the patient. Factors such as smoking cigarettes or using other tobacco products, obesity, a history of heart bypass surgery, and high blood pressure are known risk factors for the development of pulmonary hypertension. Patients with these conditions who quit smoking are found to have a significantly lower incidence of cardiovascular diseases, especially sudden death. Patients with acute pulmonary capillary disease also show a lower incident of mortality when they quit smoking.
Pulmonary hypertension is related to the left ventricular failure in patients with cardiomyopathy. Pulmonary capillary dysfunction, especially left ventricular wall damage caused by congenital or acquired heart disease, is one of the main underlying causes of the disease. When left ventricular failure develops, it is usually accompanied by pulmonary hypertension, as the disease often accompanies a sudden decline in cardiac output. This relationship is further strengthened when the patient loses consciousness due to a heart attack or stroke.
Pulmonary hypertension is an acute form of coronary artery disease. Coronary artery disease is the principal cause of ischemic heart attacks, which involve insufficient flow through coronary arteries. Pulmonary hypertension is the second most common cause of ischemic heart disease, after ischemic heart attacks. Pulmonary hypertension is the accumulation of excessive blood pressure in the lungs, resulting in inadequate blood flow through the pulmonary arteries.
The best treatment for pulmonary hypertension in patients with congenital heart disease is targeted at increasing the mean pulmonary artery pressure (MPA), which is the maximum blood pressure achieved after normal breathing. Treatment in this group usually involves a combination of medication, surgery, and lifestyle changes, such as quitting smoking and losing weight. Medications used to treat hypertension include diuretics, beta-blockers, anticholinergic drugs, calcium channel blockers, and vasoconstrictors. These drugs reduce the back pressure from the heart by constricting the arterioles, reducing the size of the heart, and eventually relaxing the muscles of the heart. Smoking cessation and weight loss also substantially decrease blood pressure in this group of patients.
The best treatment for severe hypertension in patients with acute congestive heart failure (chronic obstructive pulmonary disease, CVD) will vary according to the extent of the heart disease. Some patients may require surgery, or intensive hospital care including specialized cardiac and lung rehabilitation. Patients with a large heart, however, will usually respond to therapy with medications in this group, and should be on a strict diet plan. Medications that control high blood pressure in this group include atenolol, propranolol, and enthrone. These medications lower the mean arterial pressure (MA’s) by suppressing the sympathetic nervous system, dilating the arteries, and reducing the accumulation of cholesterol and fatty deposits in the arteries.
Some of the best treatment for pulmonary hypertension in patients with chronic obstructive lung disease will also include nocturnal oxygen therapy. Nocturnal oxygen therapy is similar to that of bed rest, except patients are encouraged to move about during the day, sleep soundly, and keep moving for short periods of time throughout the night. During the night, the patient is monitored to ensure sufficient levels of oxygen in the blood stream. During the daytime, movement and breathing are allowed to continue as usual. Patients with chronic obstructive lung disease will most likely be placed on a waiting list for invasive procedures, so prompt treatment is critical for survival.