I'm going to cover a topic that isn't often covered
in high blood pressure lectures,
and that's something called pulmonary hypertension.
Pulmonary hypertension is a series of diseases. It can be
pulmonary venous hypertension or pulmonary arterial hypertension.
The scary disease is pulmonary arterial hypertension.
We usually pick this disease up on echocardiogram.
There are a couple of treatments for pulmonary hypertension.
Remember that pulmonary hypertension is not a great disease
to have and it can result in death.
Now, we first started using what is now called Viagra,
or sildenafil, for children who had pulmonary hypertension.
And how Viagra came to be is we noticed
these little babies, these little neonates had erections,
and some enterprising physicians somewhere decided
"Hey, this would be a great drug for adults to take."
That's how Viagra came to be.
We have well tolerated treatment for pulmonary hypertension
with a phosphodiesterase type 5 inhibitors or PDE5 inhibitors.
It causes direct pulmonary vasodilation.
How it works of course, for erectile dysfunction, is
because the pulmonary blood vessels are kind of similar
to the blood vessels in the penis
in terms of a pharmacological perspective,
they both cause dilation in those vessel beds.
There is a new agent that is also a PDE5 inhibitor,
it is cheaper, but it does have more side effects.
Now, the mainstay of treatment of pulmonary hypertension
are the endothelin receptor agonists.
Depending on where you are,
there are two or one ERAs in practice today.
Bosentan is the prototypical drug.
We also use prostaglandin active agents. These work through PGI2,
and they are considered the most effective therapies as well.
Now, in terms of memorizing things for exams,
I think the one that you want to really remember is bosentan.
If you remember prostacyclin, that's you know added bonus,
but the questions are going to be focusing on bosentan.