Circulation. 2001;104:1218-1222
doi: 10.1161/hc3601.096826
doi: 10.1161/hc3601.096826
(Circulation. 2001;104:1218.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Effect of Inhaled Iloprost Plus Oral Sildenafil in Patients With Primary Pulmonary Hypertension
From Medizinische Klinik und Poliklinik, Innere Medizin V (H.W., N.F., G.W.S.), Innere Medizin III (A.G., B.C., B.H., M.B.), and the Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (J.K.), Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
Correspondence to Dr med H. Wilkens, Medizinische Klinik und Poliklinik, Innere Medizin V, Universitätskliniken des Saarlandes, D- 66421 Homburg/Saar, Germany. E-mail inhwil{at}med-rz.uni-saarland.de
Background— The application of iloprost, a stable prostacyclin analogue, by inhalation has been shown to improve hemodynamic variables in patients with primary pulmonary hypertension. However, repetitive inhalations are required due to its short-term effects. One potential approach to prolong and increase the vasorelaxant effects of aerosolized iloprost might be to combine use with phosphodiesterase inhibitors.
Methods and Results— The short-term effects of 8.4 to 10.5 µg of aerosolized iloprost, the phosphodiesterase type 5 inhibitor sildenafil, and the combination thereof were compared in 5 patients with primary pulmonary hypertension. Aerosolized iloprost resulted in a more pronounced decrease in mean pulmonary arterial pressure (PAP) than sildenafil alone (9.4±1.3 versus 6.4±1.1 mm Hg; P<0.05). The reduction in mean PAP after sildenafil was maximal after the first dose (25 mg). The combination of sildenafil plus iloprost lowered mean PAP significantly more than iloprost alone (13.8±1.4 versus 9.4±1.3 mm Hg; P<0.009). No significant changes in heart rate or systemic arterial pressure were observed during any treatment. The treatments were well tolerated, without major adverse effects.
Conclusions— Sildenafil caused a long-lasting reduction in mean PAP and pulmonary vascular resistance, with a further additional improvement after iloprost inhalation. These data suggest that small doses of a phosphodiesterase type 5 inhibitor may be a useful adjunct to inhaled iloprost in the management of pulmonary hypertension.
Key Words: hypertension, pulmonary • iloprost • sildenafil
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