Haemodynamic changes in pulmonary hypertension in patients with interstitial lung disease treated with PDE-5 inhibitors.

Abstract

BACKGROUND AND OBJECTIVE:

Interstitial lung diseases (ILD) are often associated with pulmonary hypertension (PH). This study aimed to evaluate the therapeutic benefit of phosphodiesterase-5 (PDE-5) inhibitors in pulmonary hypertension secondary to ILD.

METHODS:

Patients with ILD and PH were treated with sildenafil or tadalafil. Right heart catheterization was performed before and after a minimum of 3-month treatment. In addition, lung function, 6-min walk distance (6MWD) and plasma brain natriuretic peptide (BNP) concentration were assessed.

RESULTS:

Ten ILD patients (three female, mean age 64.4 ± 9.0 years, six with idiopathic pulmonary fibrosis (IPF), four with hypersensitivity pneumonitis, (HP)) with significant precapillary PH (mean pulmonary artery pressure (PAPm) ≥ 25 mmHg, pulmonary vascular resistance (PVR) > 280 dyn*s*cm(-5) ; pulmonary artery wedge pressure (PAWPm) ≤ 15 mmHg) were treated with either sildenafil (n = 5) or tadalafil (n = 5). Pulmonary haemodynamics were severely impaired at baseline (PAPm 42.9 ± 5.4 mmHg; cardiac index (CI) 2.7 ± 0.6 L/min/m2; PVR 519 ± 131 dyn × sec × cm(-5)). After mean follow-up of 6.9 ± 5.8 months an increase in CI (2.9 ± 0.7 L/min/m2 , P = 0.04) and a decrease in PVR (403 ± 190 dyn × sec × cm(-5) , P = 0.03) were observed. 6MWD and BNP did not change significantly.

CONCLUSIONS:

Our data suggest that treatment with PDE-5 inhibitors improves pulmonary haemodynamic patients with PH secondary to ILD.

• Authors: Gregor S Zimmermann, Werner von Wulffen, Patrick Huppmann, Tobias Meis, Franziska Ihle, Jens Geiseler, Hanno H Leuchte, Amanda Tufman, Juergen Behr, Claus Neurohr
• Journal: Respirology (Carlton, Vic.) (Respirology) Vol. 19 Issue 5 Pg. 700-6 (Jul 2014) ISSN: 1440-1843 [Electronic] Australia
• PMID: 24697923 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: © 2014 Asian Pacific Society of Respirology.

Chemical References

• Carbolines
• Phosphodiesterase 5 Inhibitors
• Piperazines
• Purines
• Sulfonamides
• Natriuretic Peptide, Brain
• Tadalafil
• Sildenafil Citrate

Topics

• Aged
• Aged, 80 and over
• Carbolines (therapeutic use)
• Female
• Follow-Up Studies
• Hemodynamics (drug effects, physiology)
• Humans
• Hypertension, Pulmonary (etiology, physiopathology)
• Lung Diseases, Interstitial (complications, drug therapy, physiopathology)
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Phosphodiesterase 5 Inhibitors (pharmacology, therapeutic use)
• Pilot Projects
• Piperazines (therapeutic use)
• Purines (therapeutic use)
• Respiratory Function Tests
• Sildenafil Citrate
• Sulfonamides (therapeutic use)
• Tadalafil
• Walking (physiology)