Review Question - QID 103006

This elderly patient has pulmonary hypertension secondary to either HFpEF or COPD. Given the vasodilator response, this patient is most likely to have favorable outcomes from long term therapy with a calcium channel blocker, amlodipine.

Pulmonary hypertension is frequently suggested in echocardiogram reports that note elevated pulmonary artery pressure. Right heart catheterization confirms diagnosis of pulmonary hypertension. During this procedure, acute vasodilator testing is performed to determine how much pulmonary blood vessels can relax and to screen patients who may respond well to calcium channel blockers.

Nauser and Stites review presentation, workup, and management of pulmonary hypertension. Comorbidities including heart failure, obstructive and restrictive lung diseases, sleep apnea, and chronic thromboembolic pulmonary hypertension are more common causes of pulmonary hypertension. Primary pulmonary hypertension is a diagnosis of exclusion. The authors note that calcium channel blockers, when used in the appropriate patient, can improve survival.

Sajkov et al. have studied effectiveness of amlodipine and felodipine in COPD patients with pulmonary hypertension. Although the study is underpowered, they report that the dose-response curves are similar for both drugs, but that amlodipine therapy was associated with fewer side effects.

Incorrect Answers:
Answers 1 and 2: These drugs are used in acute vasodilator challenges during right heart catheterizations and have short half-lives.
Answers 3 and 5: Bosentan is an endothelin receptor antagonist, while sildenfail is a PDE-5 inhibitor. Both are viable drugs if a patient fails the acute vasodilator challenge.