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EARLY PROMISE FOR TREATMENT OF PULMONARY HYPERTENSION (pp 1113, 1119)
October 03, 2001Encouraging results of a randomised trial in this week’s issue of THE LANCET suggest that the drug bosentan could play an important future role in the treatment of pulmonary hypertension.
Pulmonary hypertension (raised pressure in the blood vessels supplying the lungs) causes thickening of the right ventricle of the heart and can be associated with chest pain and heart failure. Primary pulmonary hypertension is rare (affecting around 1 in 2 million people), but secondary disease is thought to affect tens of thousands of people every year. Treatment with conventional blood-pressure-lowering drugs is not effective. Endothelin 1, a powerful endogenous vasoconstrictor, is thought to be a possible cause of the disorder. Richard Channick and colleagues from the University of California San Diego, USA, investigated whether bosentan, a dual endothelin-receptor antagonist that can be taken orally, was effective in treating patients with severe pulmonary hypertension.
32 patients were randomly assigned either bosentan (62.5 mg taken twice daily for 4 weeks then 125 mg twice daily) or placebo for a minimum of 12 weeks. Patients given bosentan did better in a six-minute walking test at 12-week follow-up (average increase of 70 metres) compared with patients given placebo (average decrease of six metres). Treatment with bosentan substantially improved cardiopulmonary haemodynamics from baseline to week 12 compared with placebo: pulmonary vascular resistance fell substantially from baseline in patients given bosentan, and rose in those given placebo; treatment with bosentan decreased the average pulmonary artery pressure, the pulmonary capillary wedge pressure, and the average right-atrial pressure. All three measures increased in the placebo group.
Richard Channick comments: “Our results suggest that endothelin plays an important part in the pathogenesis and evolution of pulmonary hypertension. Oral use of a dual endothelin-receptor antagonist, such as bosentan, which blocks both ETA and ETB receptors, could be a new therapeutic approach for this disease.”
In an accompanying Commentary (p 1113), Jocelyn Dupuis from the Montreal Heart Institute, Canada, concludes: “Future trials should help clinicians better define the place of these agents [endothelin-receptor antagonists] in the therapy of pulmonary hypertension. They should also be designed to answer other important issues, such as improvement in survival, and the role of these agents in class IV patients with or without concomitant epoprostenol therapy.”
Contact: Kate Deely Smith, UCSD Health Sciences Communications, 200 West Arbor Drive, San Diego, CA 92103-8230 T) +1 619 543 6163; F) +1 619 543 5423 ; E) kdeely@ucsd.edu
Dr Jocelyn Dupuis, Montreal Heart Institute and University of Montreal, Montreal, Quebec H1T 1C8, Canada; T) +1 514 376 3330 ext. 3542 ; F) +1 514 376 1355 ; E) dupuisj@icm.umontreal.ca
Lancet
Richard Channick comments: “Our results suggest that endothelin plays an important part in the pathogenesis and evolution of pulmonary hypertension. Oral use of a dual endothelin-receptor antagonist, such as bosentan, which blocks both ETA and ETB receptors, could be a new therapeutic approach for this disease.”
In an accompanying Commentary (p 1113), Jocelyn Dupuis from the Montreal Heart Institute, Canada, concludes: “Future trials should help clinicians better define the place of these agents [endothelin-receptor antagonists] in the therapy of pulmonary hypertension. They should also be designed to answer other important issues, such as improvement in survival, and the role of these agents in class IV patients with or without concomitant epoprostenol therapy.”
Contact: Kate Deely Smith, UCSD Health Sciences Communications, 200 West Arbor Drive, San Diego, CA 92103-8230 T) +1 619 543 6163; F) +1 619 543 5423 ; E) kdeely@ucsd.edu
Dr Jocelyn Dupuis, Montreal Heart Institute and University of Montreal, Montreal, Quebec H1T 1C8, Canada; T) +1 514 376 3330 ext. 3542 ; F) +1 514 376 1355 ; E) dupuisj@icm.umontreal.ca
Lancet
Hypertension Current Events and Hypertension News RSSMenopause-cardiology consensus statement on cardiovascular disease and on HRT
A menopause-cardiology consensus statement has called for direct action to prevent cardiovascular disease (CVD) in menopausal women. The statement also concludes that there is little evidence of increased CVD risk in taking HRT.
High Blood Pressure Easy to Miss in Children with Kidney Disease
Spot blood pressure readings in children with chronic kidney disease often fail to detect hypertension - even during doctor's office visits - increasing a child's risk for serious heart problems, according to research from Johns Hopkins Children's Center and other institutions. A report of the findings appears online in the Journal of American Society of Nephrology.
Dispensing prescription drugs in 3-month supplies reduces drug costs by a third
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Drug for erectile dysfunction improves heart function in young heart-disease patients
Heart function significantly improved in children and young adults with single-ventricle congenital heart disease who have had the Fontan operation following treatment with sildenafil, a drug used to treat erectile dysfunction and pulmonary hypertension, say researchers from The Children's Hospital of Philadelphia.
Pivotal study for PSD502 -- the first potential treatment for premature ejaculation
At the annual meeting of the Sexual Medicine Society of North America (SMSNA), Inc. in San Diego, Sciele Pharma, Inc., a Shionogi Company and Plethora Solutions Limited, a wholly owned subsidiary of Plethora Solutions Holdings PLC ("Plethora" - AIM:PLE)., today presented data from its second positive pivotal study of PSD502 for the treatment of premature ejaculation (PE).
Night Beat, Overtime and a Disrupted Sleep Pattern Can Harm Officers' Health
A police officer who works the night shift, typically from 8 p.m. to 4 a.m., already is at a disadvantage when it comes to getting a good "night's" sleep.
At-risk college students reduce HBP, anxiety, depression through Transcendental Meditation
The Transcendental Meditation technique may be an effective method to reduce blood pressure, anxiety, depression, and anger among at-risk college students, according to a new study to be published in the American Journal of Hypertension, December 2009.
Faithful mothers have healthier babies
Faculty of 1000 reviewers examine a study from New Zealand on whether prolonged exposure to the father's semen protects new mothers against pre-eclampsia and having an undersized baby
Size matters: Obesity leading risk factor of left atrial enlargement during aging
Aside from aging itself, obesity appears to be the most powerful predictor of left atrial enlargement (LAE), upping one's risk of atrial fibrillation (the most common type of arrhythmia), stroke and death.
Study examines quality and duration of primary care visits
Adult primary care visits have increased in quality, duration and frequency between 1997 and 2005, according to a report in the November 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
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