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Acute vasodilator response to vardenafil and clinical outcome in patients with pulmonary hypertension.
Sandqvist, Anna; Henrohn, Dan; Egeröd, Hanna; Hedeland, Mikael; Wernroth, Lisa; Bondesson, Ulf; Schneede, Jörn; Wikström, Gerhard.
Afiliación
  • Sandqvist A; Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden. anna.sandqvist@umu.se.
  • Henrohn D; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  • Egeröd H; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  • Hedeland M; Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden.
  • Wernroth L; Department of Medicinal Chemistry, Division of Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden.
  • Bondesson U; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
  • Schneede J; Department of Chemistry, National Veterinary Institute (SVA), Uppsala, Sweden.
  • Wikström G; Department of Medicinal Chemistry, Division of Analytical Pharmaceutical Chemistry, Uppsala University, Uppsala, Sweden.
Eur J Clin Pharmacol ; 71(10): 1165-73, 2015 Oct.
Article en En | MEDLINE | ID: mdl-26242227
PURPOSE: Acute vasodilator testing is recommended in patients with pulmonary arterial hypertension to identify individuals who may benefit from long-term treatment with oral calcium channel blockers. The aim of this study was to investigate the use of vardenafil in acute vasoreactivity testing compared to adenosine. METHODS: A total of 20 patients eligible for right heart catheterisation were enrolled. Acute vasoreactivity testing was carried out with intravenous (iv) adenosine (n = 18) followed by oral vardenafil (n = 20). Haemodynamic responses were recorded at baseline and after 60 min (vardenafil). Responders were defined according to consensus guideline criteria. RESULTS: Both vardenafil and adenosine significantly decreased mean pulmonary arterial pressure (mPAP, p < 0.001 and p = 0.026, respectively) and pulmonary vascular resistance (p < 0.001 and p > 0.001, respectively), and significantly increased cardiac output (p = 0.001 and p = 0.005, respectively). Vardenafil reduced mPAP more than adenosine (p = 0.044), while adenosine resulted in higher responses of cardiac index (p = 0.009) and pulmonary arterial oxygen saturation (p = 0.042). Acute adverse reactions were common with adenosine, while no side effects were observed after a single oral dose vardenafil. Vardenafil identified five responders (out of 20), while adenosine identified three responders (out of 18). During a 7-year follow-up, vardenafil responders had significantly lower NT-proBNP levels compared to non-responders. CONCLUSIONS: Vardenafil may be safely used for acute vasoreactivity testing in patients with PH. A single oral dose of vardenafil is better tolerated than iv adenosine and may identify additional responders who could benefit from long-term vasodilator treatment.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vasodilatadores / Adenosina / Diclorhidrato de Vardenafil / Hipertensión Pulmonar Tipo de estudio: Guideline / Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Clin Pharmacol Año: 2015 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vasodilatadores / Adenosina / Diclorhidrato de Vardenafil / Hipertensión Pulmonar Tipo de estudio: Guideline / Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Clin Pharmacol Año: 2015 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Alemania