Blockers of angiotensin receptors: a novel approach to treatment of secondary pulmonary hypertension

Aim. To evaluate efficacy of losartan, a blocker of angiotensin receptors, in combined treatment of secondary pulmonary hypertension (SPH) in patients with chronic obstructive bronchitis (COB). Material and methods. Losartan effects on hemodynamics, blood gases and clinical course of the disease were studied in 29patients with COB and SPH (mean age 52 ± 1.7years). A control group consisted of 15 patients (mean age 51 ± 1.5 years) treated with cardiac glycosides and diuretic drugs. Aland B-mode Doppler echocardiography registered hemodynamic parameters. 24-h monitoring of AP and ECG were made by standard methods. Blood gases and venous rheology were examined. Results. Losartan administration in COB patients with SPH improved hemodynamics. Stroke index rose from 36.3 ± 2.1 to 45.8 ± 2.1 ml/m1 (by 26.2%, p < 0.01) in SPH functional class III, from
26.3 ± 1.9 to 32.7 ± 2.1 ml/m2 (by 24.3%, p < 0.01) in functional class IV. Cardiac index rose by 22.2 and 21.1%, respectively. Pulmonary hemodynamics improved too: systolic pressure in pulmonary artery fell by 25.7% in functional class HI, by 18.6% in functional class IV. Losartan normalized a 24-h AP profile, reduced the number of painless myocardial ischemia.
Conclusion. Use of losartan in combined therapy of patients with COB and SPH improves clinical status of the patients, corrects basic cardiohemodynamic parameters, has a positive effect on AP profiles without negative impact on blood gas composition and rheology.

secondary pulmonary hypertension, treatment, losartan, hemodynamics, blood viscosity, blood gases