Department of Pharmacotherapy and Translational Research Center for Pharmacogenomics and Precision Medicine University of Florida College of Pharmacy Gainesville FL.
Division of Pulmonary, Critical Care & Sleep Medicine University of Florida College of Medicine Gainesville FL.
J Am Heart Assoc. 2021 Jun;10(11):e020633. doi: 10.1161/JAHA.120.020633. Epub 2021 May 25.
Pulmonary hypertension (PH) attributable to left heart disease (LHD) is believed to be the most common form of PH and is strongly associated with increased mortality and morbidity in this patient population. Specific therapies for PH-LHD have not yet been identified and the use of pulmonary artery hypertension-targeted therapies in PH-LHD are not recommended. Endothelin receptor antagonists, phosphodiesterase-5 inhibitors, guanylate cyclase stimulators, and prostacyclins have all been studied in PH-LHD with conflicting results. Understanding the mechanisms underlying PH-LHD could potentially provide novel therapeutic targets. Fibrosis, oxidative stress, and metabolic syndrome have been proposed as pathophysiological components of PH-LHD. Genetic associations have also been identified, offering additional mechanisms with biological plausibility. This review summarizes the evidence and challenges for treatment of PH-LHD and focuses on underlying mechanisms on the horizon that could develop into potential therapeutic targets for this disease.
左心疾病相关肺动脉高压（PH）被认为是最常见的 PH 类型，与该患者人群的死亡率和发病率增加密切相关。尚未确定针对 PH-LHD 的特定治疗方法，不建议在 PH-LHD 中使用肺动脉高压靶向治疗。内皮素受体拮抗剂、磷酸二酯酶-5 抑制剂、鸟苷酸环化酶刺激剂和前列环素在 PH-LHD 中的研究均得出相互矛盾的结果。了解 PH-LHD 的潜在机制可能为新的治疗靶点提供依据。纤维化、氧化应激和代谢综合征已被提出作为 PH-LHD 的病理生理成分。遗传关联也已被确定，提供了具有生物学合理性的额外机制。本综述总结了 PH-LHD 治疗的证据和挑战，并重点介绍了潜在的治疗靶点，这些靶点可能成为该疾病的潜在治疗靶点。
