Treatments for Primary pulmonary hypertension
Treatments for Primary pulmonary hypertension
The list of treatments mentioned in various sources
for Primary pulmonary hypertension
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
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Some patients do well by taking medicines
that make the work of the right ventricle easier. Anticoagulants, for example,
can decrease the tendency of the blood to clot, thereby permitting blood to flow
more freely. Diuretics decrease the amount of fluid in the body, further
reducing the amount of work the heart has to do.
Until recently, nothing more could be done for people who have PPH. However,
today doctors can choose from a variety of drugs that help lower blood pressure
in the lungs and improve the performance of the heart in many patients.
Some patients also require supplemental oxygen delivered through nasal prongs
or a mask if breathing becomes difficult; some need oxygen around the clock. In
severely affected cases, a heart-lung, single lung, or double lung
transplantation may be appropriate.
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Drugs
Doctors now know that PPH patients respond
differently to the different medicines that dilate, or relax, blood vessels
and that no one drug is consistently effective in all patients. Because
individual reactions vary, different drugs have to be tried before chronic or
long-term treatment begins. During the course of the disease, the amount and
type of medicine may also have to be changed.
To find out which medicine works best for a particular patient, doctors
evaluate the drugs during cardiac catheterization. This way they can see the
effect of the medicine on the patient's heart and lungs. They can also adjust
the dose to reduce the side effects that may occur--for example, systemic low
blood pressure (hypotension); nausea; angina; headaches; or flushing.
To determine whether a drug is improving a patient's condition, both the
pulmonary pressure and the amount of blood being pumped by the heart (the
cardiac output) must be evaluated. A decrease in pulmonary pressure alone, for
example, does not necessarily mean that the patient is recovering; cardiac
output must either increase or remain unchanged. The most desirable response
is a decrease in pressure and an increase in cardiac output. Once the patient
has reached a stable condition, he or she can go home, returning every few
weeks or months to the doctor for followup.
At present, approximately one-quarter to one-half of patients can be
treated with calcium channel blocking drugs given by mouth. By relaxing the
smooth muscle in the walls of the heart and blood vessels, these calcium
channel blockers improve the ability of the heart to pump blood.
A vasodilator, prostacyclin, is helping some severely ill patients who are
unresponsive to treatment with calcium channel blockers. The drug, which has
been studied in clinical trials, imitates the natural prostacyclin that the
body produces on its own to dilate blood vessels. Prostacyclin also seems to
help prevent blood clots from forming.
Prostacyclin is administered intravenously by a portable, battery-operated
pump. The pump is worn attached to a belt around the waist or carried in a
small shoulder pack. The medication is then slowly and continuously pumped
into the body through a permanent catheter placed in a vein in the neck.
Protstacyclin seems to improve pulmonary hypertension and permit more
physical activity. It is sometimes used as a bridge to help those patients
waiting for a transplant, while in other cases it is used for long-term
treatment.
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Transplantation
The first heart-lung transplant was
performed in this country in 1981. Many of these operations were performed for
patients with PPH. The survival rate is the same as for other patients with
heart-lung transplants, about 60 percent for 1 year, and 37 percent for 5
years.
The single lung transplant is the most common method of transplant used in
cases of PPH. This procedure, in which one lung--either the left or right--is
replaced, was first performed in 1983 in patients with pulmonary fibrosis.
Double lung transplants are also done to treat PPH, but are less common than
the single lung transplant for treatment of PPH.
There are fewer complications with the single lung transplant than with the
heart-lung transplant, and the survival rate is on the order of 70 percent for
1 year. A surprising finding is the remarkable ability of the right ventricle
to heal itself. In patients with lung transplants, both the structure and
function of the right ventricle markedly improve. Complications of
transplantation include rejection by the body of the transplanted organ, and
infection. Patients take medications for life to reduce their body's immune
system's ability to reject "foreign" organs.
(Source: excerpt from
NHLBI, Facts About Primary Pulmonary Hypertension: NHLBI)
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Hypertension:
Treatment
(In a Page: Signs and Symptoms)
-
Essential hypertension: Lifestyle changes are the initial interventions unless significant hypertension, end-organ damage, or diabetes is present (smoking cessation; dietary changes, e.g., DASH diet =low in sodium, rich in potassium and calcium; increased exercise)
-
Pharmacologic therapy usually begins with a diuretic or β-blocker (ACE inhibitor in diabetics)
–Diuretics are usually first-line agents, especially in CHF, diabetes, and risk of coronary artery disease
–Use ACE inhibitors in patients with CHF, MI, renal disease, and diabetes
–Use β-blockers in CAD, recent MI, angina, CHF, atrial fibrillation, migraines, hyperthyroidism
–Additional drugs may include angiotensin receptor blockers (especially in patients with cough when using ACE inhibitors), calcium channel blockers, and β-blockers
–Preferred drugs in pregnancy include methyldopa, β-blockers, and vasodilators (do not use ACE/ARBs)
'>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hypertension:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treat the underlying disease when possible
-
Stop smoking and illicit drug use
-
Avoid the offending drug when possible
-
Limit competitive sports and highly static exercises in patients with severe hypertension only until their BP is controlled and there is no evidence of end organ damage
-
Salt restriction (4–5 g/day), weight loss, and exercise are part of most regimens
-
Essential hypertension can usually be resolved with weight loss, moderate exercise, and dietary modifications
-
For other etiologies, many medications are used to control
blood pressure
–IV: Nicardipine, sodium nitroprusside, labetalol
–Oral: Captopril, enalapril, lisinopril, amlodipine,
nifedipine extended release, propranolol, clonidine, hydralazine
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Pulse pressure, widened:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient’s level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs. Maintain a patent airway, and prepare to hyperventilate the patient with a handheld resuscitation bag to help reduce partial pressure of carbon dioxide levels and, thus, ICP. Perform a thorough neurologic examination to serve as a baseline for assessing subsequent changes. Use the Glasgow Coma Scale to evaluate the patient’s LOC. (See Glasgow Coma Scale, page 374.) Also, check cranial nerve function — especially in cranial nerves III, IV, and VI — and assess pupillary reactions, reflexes, and muscle tone. Insertion of an ICP monitor may be necessary. If you don’t suspect increased ICP, ask about associated symptoms, such as chest pain, shortness of breath, weakness, fatigue, or syncope. Check for edema, and auscultate for murmurs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hypertension:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The National Institutes of Health recommend the following approach for treating primary hypertension:
❑ First, help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.
❑ If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy.
❑ For stage 1 hypertension (systolic [SBP] blood pressure 140 to 159 mm Hg, or diastolic blood pressure [DBP] 90 to 99 mm Hg) in the absence of compelling indications (heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, or recurrent stroke prevention), give most patients thiazide-type diuretics. Consider using an angiotensin-converting enzyme (ACE) inhibitor, beta-adrenergic blocker, calcium channel blocker (CCB), angiotensin-receptor blocker (ARB), or a combination.
❑ For stage 2 hypertension (SBP ≥ 160 mm Hg, or DBP ≥ 100 mm Hg) in the absence of compelling indications, give most patients a two-drug combination (usually a thiazide-type diuretic and an ACE inhibitor, ARB, CCB, or beta-adrenergic blocker).
❑ If the patient has one or more compelling indications, base drug treatment on benefits from outcome studies or existing clinical guidelines. Treatment may include the following, depending on indication:
– Heart failure — diuretic, beta-adrenergic blocker, ACE inhibitor, ARB, or aldosterone antagonist
– High coronary disease risk — diuretic, beta-adrenergic blocker, ACE inhibitor, or CCB
– Diabetes — diuretic, beta-adrenergic blocker, ACE inhibitor, or CCB
– Chronic kidney disease — ACE inhibitor or ARB
– Postmyocardial failure — ACE inhibitor, beta-adrenergic blocker, or aldosterone antagonist
– Recurrent stroke prevention — diuretic or ACE inhibitor.
Give other antihypertensive drugs as needed.
❑ If the patient fails to achieve the desired blood pressure, continue lifestyle modifications and optimize drug dosages or add additional drugs until the goal blood pressure is achieved. Also, consider consultation with a hypertension specialist.
Treatment of secondary hypertension focuses on correcting the underlying cause and controlling hypertensive effects.
Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure. The initial goal is to reduce mean arterial blood pressure by no more than 25% (within minutes to hours) then to 160/110 within 2 hours while avoiding excessive falls in blood pressure that can precipitate renal, cerebral, or myocardial ischemia.
Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia or severe gestational hypertension, unstable angina, and acute myocardial infarction.
Hypertension without accompanying symptoms or target-organ disease seldom requires emergency drug therapy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pulmonary hypertension:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment usually includes oxygen therapy to decrease hypoxemia and resulting pulmonary vascular resistance. It may also include vasodilator therapy (nifedipine, diltiazem, or prostaglandin E). For patients with right-sided heart failure, treatment also includes fluid restriction, cardiac glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. Treatment also aims to correct the underlying cause.
Some patients with pulmonary hypertension may be candidates for heart-lung transplantation to improve their chances of survival.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pregnancy-induced hypertension:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include complete bed rest to increase placental perfusion, reduce hypertension, and evaluate response to therapy. Antihypertensive therapy doesn’t alter the potential for developing eclampsia. Diuretics aren’t appropriate during pregnancy.
If the patient’s blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases, magnesium sulfate may produce general sedation, promote diuresis, and prevent seizures. Cesarean birth or oxytocin induction may be required to terminate the pregnancy.
Emergency treatment of eclamptic seizures consists of immediate administration of magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the seizures subside and the patient’s condition stabilizes, delivery should proceed with induction of labor or cesarean birth, depending upon the circumstances.
Adequate nutrition, good prenatal care, and control of pre-existing hypertension during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hypertensive crisis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Nitroprusside, nitroglycerin, diazoxide, hydralazine, methyldopa
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Renovascular hypertension:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Surgery, the treatment of choice, is performed to restore adequate circulation and to control severe hypertension or severely impaired renal function by renal artery bypass, endarterectomy, arterioplasty or, as a last resort, nephrectomy. Balloon catheter renal artery dilation is used in selected cases to correct renal artery stenosis without the risks and morbidity of surgery. Symptomatic measures include antihypertensives, diuretics, and a sodium-restricted diet.
Medications that may be used in an attempt to control blood pressure include diuretics, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and alpha-adrenergic blockers. Diazoxide or nitroprusside may be given in the hospital if symptoms are acute. Response to medications is highly individual and the dosage or specific drug used may need frequent adjustment.
Lifestyle changes may be recommended, including weight, exercise, dietary adjustments, smoking cessation, and avoidance of alcohol. These habits add to the effects of hypertension in causing complications.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pulse pressure, widened:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ifthe patient’s level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs and oxygen saturation. Maintain a patent airway. Provide supplemental oxygen and ventilatory support to keep the patient’s partial pressure of arterial oxygen above 90 mm Hg or his oxygen saturation above 95%. Give osmotic diuretics, such as mannitol, by I.V. infusion to decrease ICP. Insert an indwelling urinary catheter; monitor intake and output during mannitol therapy. Start ICP monitoring. Administer analgesics as ordered. Hyperventilation therapy to decrease the patient’s partial pressure of arterial carbon dioxide and to treat ICP remains controversial but may be needed for short intervals when ICP and neurologic deterioration increase. Perform a neurologic examination. Use the Glasgow Coma Scale (see page 480) to evaluate LOC. Check cranial nerve function—especially cranial nerves III, IV, and VI—and assess papillary reactions, reflexes, and muscle tone. Continue ICP monitoring. If you don’t suspect increased ICP, ask about associated symptoms, such as chest pain, shortness of breath, weakness, fatigue, or syncope. Check for edema and auscultate for murmurs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Blood pressure increase [Hypertension]:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Encourage the patient to lose weight, if necessary, and to restrict sodium intake. Suggest that he participate in an exercise or stress management program as well. Then teach the patient how to monitor his blood pressure so that he can evaluate the effectiveness of drug therapy and lifestyle changes. Have him record blood pressure readings and symptoms, and ask him to share this information on his return visits.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hypertension:
Treatment
(Handbook of Diseases)
Secondary hypertension treatment focuses on correcting the underlying cause and controlling hypertensive effects.
The National Institutes of Health recommend the following approach for treating primary hypertension:
❑ First, help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.
❑ If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy.
❑ For stage 1 hypertension (systolic [SBP] blood pressure 140 to 159 mm Hg, or diastolic blood pressure [DBP] 90 to 99 mm Hg) in the absence of compelling indications (heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, or recurrent stroke prevention), give most patients thiazide-type diuretics. Consider using an angioten-sin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-adrenergic blocker (BB), calcium channel blocker (CCB), or a combination.
❑ For stage 2 hypertension (SBP ≥ 60 mm Hg, or DBP ≥ 100 mm Hg) in the absence of compelling indications, give most patients a two-drug combination (usually a thiazide-type diuretic and an ACEI, ARB, BB, or CCB).
❑ If the patient has one or more compelling indications, base drug treatment on benefits from outcome studies or existing clinical guidelines. Treatment may include the following, depending on indication:
❑ Heart failure — diuretic, BB, ACEI, ARB, or aldosterone antagonist
❑ Post myocardial infarction — BB, ACEI, or aldosterone antagonist
❑ High coronary disease risk — diuretic, BB, ACEI, or CCB
❑ Diabetes — diuretic, BB, ACEI, ARB, or CCB
❑ Chronic kidney disease — ACEI or ARB
❑ Recurrent stroke prevention — diuretic or ACEI.
Give other antihypertensive drugs as needed.
❑ If the patient fails to achieve the desired blood pressure, continue lifestyle modifications and optimize drug dosages or add additional drugs until the goal blood pressure is achieved. Also, consider consultation with a hypertension specialist.
UNDER STUDY: Studies have shown that omega-3 fatty acids used in the treatment of hypertension significantly reduce total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and lower systolic and diastolic blood pressure.
Clinical tip The treatment for renal artery stenosis includes the use of ACE inhibitors and renal artery stents.
Hypertensive emergencies
Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia and severe pregnancy-induced hypertension, unstable angina, and acute MI.
Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pulmonary hypertension:
Treatment
(Handbook of Diseases)
Appropriate treatment usually includes oxygen therapy to decrease hypoxemia and resulting pulmonary vascular resistance. For patients with right-sided heart failure, treatment also includes fluid restriction, cardiac glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. An important goal of treatment is correction of the underlying cause.
CLINICAL TIP: Patients with primary pulmonary hypertension usually respond to epoprostenol (PGI2) as a continuous home infusion.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hypertension, pregnancy-induced:
Treatment
(Handbook of Diseases)
Adequate nutrition, good prenatal care, and control of preexisting hypertension with hydralazine during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.
Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach.
Conservative measures
Therapy may include sedatives, such as phenobarbital, along with complete bed rest to relieve anxiety, reduce hypertension, and evaluate response to therapy. If renal function remains adequate, a high-protein, low-sodium, low-carbohydrate diet with increased fluid intake is recommended.
If blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg or if CNS irritability increases, magnesium sulfate may produce general sedation, promote diuresis, reduce blood pressure, and prevent seizures.
Cesarean delivery
If these measures fail to improve the patient’s condition or if fetal life is endangered (as determined by stress or nonstress tests), cesarean delivery or oxytocin induction may be required to terminate the pregnancy.
Treatment for seizures
Emergency treatment of eclamptic seizures consists of immediate administration of I.V. diazepam, followed by magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the patient’s condition stabilizes, a cesarean delivery may be performed.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pulse pressure, widened:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
If the patient displays increased ICP, continually reevaluate his neurologic status and compare your findings carefully with those of previous evaluations. Stay alert for restlessness, confusion, unresponsiveness, or a decreased LOC. Keep in mind, however, that increasing ICP is commonly signaled by subtle changes in the patient’scondition, rather than the abrupt development of any one sign or symptom.
Patient teaching
Explain needed dietary modifications such as restricted sodium and saturated fats. Stress the importance of planning rest periods. If the patient has a decreased LOC, discuss specific safety measures. If the condition is related to increased body temperature, discuss fever management, proper cooling measures if exposed to excessive heat for long periods, and proper fluid consumption with the patient.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Pulse pressure, widened:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ifthe patient’s level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs. Maintain a patent airway, and prepare to hyperventilate the patient with a handheld resuscitation bag to help reduce partial pressure of carbon dioxide levels and, thus, ICP. Perform a thorough neurologic examination to serve as a baseline for assessing subsequent changes. Use the Glasgow Coma Scale to evaluate the patient’s LOC. (See Glasgow Coma Scale, page 396.) Also, check cranial nerve function — especially in cranial nerves III, IV, and VI — and assess pupillary reactions, reflexes, and muscle tone. Insertion of an ICP monitor may be necessary. Check for edema and auscultate for murmurs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse pressure, widened:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ If the patient displays increased ICP, continually evaluate his neurologic status.
▪ Be alert for restlessness, confusion, unresponsiveness, or decreased LOC.
▪ Watch for subtle changes in the patient's condition.
Patient teaching
▪ Explain diagnostic tests, such as blood studies, computed tomography scan, and magnetic resonance imaging.
▪ Explain the underlying disorder and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Blood pressure, increased [Hypertension]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ If routine screening detects elevated blood pressure, prepare the patient for routine blood tests, urinalysis, and depending on the suspected cause of the increased blood pressure, radiographic studies, especially of the kidneys.
▪ Administer antihypertensives, as ordered, and evaluate their effect.
Patient teaching
▪ Explain the importance of regular blood pressure monitoring and keeping follow-up appointments.
▪ Explain how to take prescribed antihypertensives correctly and adverse effects that should be reported.
▪ Instruct the patient not to discontinue medications without contacting the practitioner.
▪ Emphasize the importance of weight loss and regular exercise.
▪ Explain the need for sodium restriction.
▪ Discuss stress management.
▪ Discuss ways of reducing other risk factors for coronary artery disease, such as smoking cessation and lowering elevated cholesterol levels.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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