Clinic III for Internal Medicine, Heart Center at University of Cologne, Cologne, Germany.
Int J Cardiol. 2011 Dec;154 Suppl 1:S34-44. doi: 10.1016/S0167-5273(11)70491-0.
The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension (PH) have been adopted for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more frequent forms of PH including PH owing to left heart disease. The guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors) have not been sufficiently investigated in other forms of PH. However, despite the lack of respective efficacy data an uncritical use of targeted PAH drugs in patients with PH associated with left heart disease is currently observed at an increasing rate. This development is a matter of concern. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH due to left heart disease. This commentary describes in detail the results and recommendations of the working group which were last updated in October 2011.
2009 年欧洲肺动脉高压（PH）诊断和治疗指南已被德国采纳。虽然该指南包含了关于肺动脉高压（PAH）的详细建议，但仅包含了相对较短的一段关于其他更常见形式的 PH 的内容，包括由于左心疾病引起的 PH。该指南指出，目前用于治疗 PAH 患者的药物（前列腺素、内皮素受体拮抗剂和磷酸二酯酶 5 抑制剂）在其他形式的 PH 中尚未得到充分研究。然而，尽管缺乏相应的疗效数据，目前仍在未经批判性地使用靶向 PAH 药物治疗伴有左心疾病的 PH 患者，而且这种趋势还在不断增加。这一发展令人担忧。另一方面，PH 是一个常见的问题，对左心疾病患者的发病率和死亡率有很大影响。因此，德国需要考虑一些特定问题和现有的新数据，以实际执行欧洲指南。这需要对指南进行详细的评论，在某些方面已经需要更新。2010 年 6 月，由德国心脏病学会（DGK）、德国呼吸学会（DGP）和德国儿科心脏病学会（DGPK）的 PH 工作组在德国科隆组织了一次共识会议。该会议旨在解决在德国实施欧洲指南时出现的实际和有争议的问题。为此，成立了多个工作组，其中一个专门针对左心疾病引起的 PH。本评论详细描述了工作组的结果和建议，该工作组的最后更新时间为 2011 年 10 月。
