Reeves J T, Groves B M, Turkevich D
Am Rev Respir Dis. 1986 Aug;134(2):342-6. doi: 10.1164/arrd.1986.134.2.342.
The treatment of primary pulmonary hypertension with pulmonary vasodilator agents is controversial. Some patients have benefited, while others have not. To shed light on the mater we reviewed published reports of 117 patients having acute vasodilator challenge and found that 53 reduced their pulmonary vascular resistance by 30% or more. Calcium antagonists (n = 46), hydralazine (n = 23), and diazoxide (n = 18) gave approximately equivalent acute reductions in resistance (30%, 35%, 32%, respectively), but captopril (n = 17) gave a poor response (-7%). The reports indicated that chronic treatment (3 months or longer) benefited only 4 of 64 patients (6%) having acute reduction in resistances of less than 30%. However, when resistance was lowered acutely by more than 30%, 33 of 53 patients (62%) improved with treatment. In 5 patients having multiple catheterization, improvement was sustained for the duration of follow-up (10 to 48 months). Except for captopril, the agents employed gave similar reductions in resistance, and perhaps the choice should be determined by avoidance of side-effects. Long-term benefit is never certain, but selecting patients with brisk acute vasodilator responses may predict the benefit from chronic vasodilator treatment.
使用肺血管扩张剂治疗原发性肺动脉高压存在争议。一些患者从中受益，而另一些患者则没有。为了阐明这一问题，我们回顾了117例接受急性血管扩张剂激发试验患者的已发表报告，发现其中53例患者的肺血管阻力降低了30%或更多。钙拮抗剂（46例）、肼屈嗪（23例）和二氮嗪（18例）使阻力急性降低的幅度大致相当（分别为30%、35%、32%），但卡托普利（17例）反应较差（-7%）。报告表明，对于64例急性阻力降低小于30%的患者，只有4例（6%）从慢性治疗（3个月或更长时间）中受益。然而，当阻力急性降低超过30%时，53例患者中有33例（62%）经治疗后病情改善。在5例接受多次导管插入术的患者中，病情改善在随访期间（10至48个月）持续存在。除卡托普利外，所使用的药物使阻力降低的幅度相似，也许选择应根据避免副作用来决定。长期获益并不确定，但选择急性血管扩张剂反应活跃的患者可能预示着慢性血管扩张剂治疗会带来益处。
