As compared with base line, after three months of treatment with aerosolized iloprost there was significant improvement in the values before the inhalation of iloprost for mean pulmonary arterial pressure, mean right atrial pressure, pulmonary vascular resistance, stroke volume, and mixed venous oxygen saturation (). These effects were sustained at 12 months. At this time, there was also a significant increase in cardiac output as compared with base line, suggesting effective improvement in right ventricular performance with long-term administration of aerosolized iloprost. As compared with base line, preinhalation mean pulmonary arterial pressure was reduced by 7±8.7 mm Hg after 12 months of treatment (mean change, –12 percent; P=0.006), pulmonary vascular resistance by 280±323 dyn․sec․cm–5 (mean change, –23 percent; P). Thirteen of the 24 patients (54 percent) had a long-term reduction of at least 20 percent in preinhalation pulmonary vascular resistance (). At all times, there was further improvement in these variables immediately after the inhalation of iloprost ().
Our data show that long-term treatment with aerosolized iloprost has beneficial effects on exercise capacity and hemodynamic variables in patients with primary pulmonary hypertension. The therapeutic efficacy of intravenous epoprostenol in primary pulmonary hypertension has been well described, but the mechanisms by which prostacyclin influences the course of the disease are incompletely understood. Several studies have shown that the long-term effects of epoprostenol in pulmonary hypertension go beyond vasodilation. Other factors involved may include antithrombotic and antiproliferative effects as well as modulating effects on growth factors and vascular remodeling. Some of these effects, such as inhibition of platelet aggregation, could outlast the presence of prostaglandins. In the case of inhaled iloprost, however, it is not yet clear whether plasma concentrations reach sufficient levels to exert an effect on platelet function.
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The English word for health is derived from the old English word ‘hale’ meaning “Wholeness and wellness”, in this essay I will be exploring the different definitions, views and models of health.
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Eric W. Cucchi, Jillian Levy. . (2017) Pulmonary Hypertension and Thrombembolism—Long-Term Management and Chronic Oral Anticoagulation. 2:4, 727-741.
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lists the baseline characteristics of the patients randomly assigned to the two groups, including key risk factors and previous cardiovascular and renal events. There were no significant differences in baseline characteristics between the patients in the two treatment groups. The mean age of the patients in this trial was 68.4 years, and 39.5% of the patients were women. Approximately half of the study population (49.6%) had a body-mass index (the weight in kilograms divided by the square of the height in meters) greater than 30, and the mean body-mass index was 31. Of note, 60.4% of the patients had a diagnosis of diabetes.
The study medication was administered in all but nine patients (seven in the benazepril–amlodipine group and two in the benazepril–hydrochlorothiazide group). The mean follow-up was 35.7 months for the benazepril–amlodipine group and 35.6 months for the benazepril–hydrochlorothiazide group. The mean duration of treatment exposure was 30.0 months and 29.3 months for the patients in the two groups, respectively. For the patients in the benazepril–amlodipine group, the mean daily dose was 36.3 mg of benazepril and 7.7 mg of amlodipine, and the median daily dose was 39.4 mg and 8.9 mg, respectively; for patients in the benazepril–hydrochlorothiazide group, the mean daily dose was 36.1 mg of benazepril and 19.3 mg of hydrochlorothiazide, and the median daily dose was 39.4 mg and 22.1 mg, respectively. By the end of the 6-month dose-adjustment period, 60.9% of the patients in the benazepril–amlodipine group were receiving the maximum dose of 40 mg of benazepril and 10 mg of amlodipine, and 60.3% of the patients in the benazepril–hydrochlorothiazide group received the maximum dose of 40 mg of benazepril and 25 mg of hydrochlorothiazide. In each group, 32.3% of the patients received approved antihypertensive agents in addition to the highest dose of study medication after 1 year in the study. At the completion of the trial, 143 participants did not provide information about vital status. Of these, 5 withdrew their consent and 21 were from sites that were closed before the end of the trial (10 from sites affected by Hurricane Katrina), leaving 117 subjects (1.0%) who were lost to follow-up.
Overall, our data support the conclusion that aerosolized iloprost is an effective treatment for primary pulmonary hypertension. Currently, phase 3 studies are under way in Europe that are expected to result in the licensing of inhaled iloprost for the treatment of pulmonary hypertension. With this approach, the options for therapy in advanced pulmonary hypertension increase, but so do the uncertainties about the optimal first-line treatment of patients with this condition. The time has come for studies comparing the long-term effects of intravenous epoprostenol and aerosolized iloprost in patients with primary pulmonary hypertension.
The baseline blood pressures were similar between the two groups, and the reduction in blood pressure from baseline was similar over the course of the trial (). Mean blood pressure after dose adjustment was 131.6/73.3 mm Hg in the benazepril–amlodipine group (5463 patients) and 132.5/74.4 mm Hg in the benazepril–hydrochlorothiazide group (5474 patients). The mean difference in blood pressure between the two groups was 0.9 mm Hg systolic and 1.1 mm Hg diastolic (P