masterThesis
Impacto terapéutico del uso de vasodilatadores pulmonares (inhibidores de la fosfodiesterasa 5 y antagonista de endotelina 1) en pacientes con hipertensión arterial pulmonar a 2600 msnm
Autor
Medina Lee, Luis David
Oliver Hernández, Gabriel Antonio
Institución
Resumen
Introduction: The treatment of pulmonary arterial hypertension is a clinical challenge, since it requires a complex and multidisciplinary strategy, based on the use of pulmonary vasodilators. Current research is mainly focused on the long-term effects of combined therapies, using strategies sequentially (monotherapy and later with additive therapy) or starting in combination; however, in Colombia we still do not have studies that evaluate the efficacy of these strategies in our population. Materials and methods: Analytical observational study with convenience sampling, where 102 patients with a diagnosis of pulmonary arterial hypertension under management with pulmonary vasodilators (phosphodiesterase 5 inhibitors and endothelin 1 antagonists) were studied, and who completed the follow-up process in the program of Pulmonary hypertension at the Colombian Neumological Foundation. The objective of the work is to determine its therapeutic impact by evaluating changes in risk stratification, NYHA functional class, progression of hemodynamic variables and progression to the use of prostanoids at 2,600 meters above sea level. Results: Of the 150 patients analyzed, 68% (N = 102) were under treatment with pulmonary vasodilators and with complete follow-up. There was a predominance of the female population (80.4%) with NYHA II and III functional class at admission (82.4%), pharmacological groups used ARE-1 (92%) and IPDE-5 (72.5%). Improvement in risk stratification was found in the 3 categories (low, medium and high risk) with respect to admission, from 6 to 12 months, and from 18 to 24 months (P = <0.001). Additionally, syncope as a marker of poor prognosis was reduced from 17.3% to 0% at 24 months of follow-up with therapy (p <0.001). There was also a trend towards improvement in functional class, mainly NYHA III and IV, with a change to NYHA I (8.8% and 3% respectively) without statistical significance (P = 0.158). In 38 patients (37.2%), the therapy was staggered to the use of prostanoids with a median time of addition (P25 - P75) of 19.8 (3.0 - 24.0) months, using the prostaglandin analogues Iloprost (47.7% ), Treprostinil (36.8%) and Epoprostenol (15.8%). Conclusions: The therapeutic impact of the use of pulmonary vasodilators is statistically significantly reflected in a reduction in risk stratification and syncope as mortality markers, with a trend towards an improvement in NYHA functional class with respect to admission. Progression to advanced therapies such as prostanoids is indicated in a median of 19 months with a predominance of 70% of these before 2 years.
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