Vasodilatory treatment of pulmonary hypertension.

Vasodilatory treatment decreases exercise dyspnoea in the majority of patients with primary pulmonary hypertension, due to an increase of cardiac output. Pulmonary vascular resistance declines, but pulmonary arterial pressure decreases only in some patients. Basically, the cause of the difference among "responders" and "non-responders" to this type of therapy is not known. The presence of hypertensive vascular changes in the pulmonary circulation may be a possible explanation for a lack of positive response to vasodilator treatment. This treatment is not without side effects and needs careful clinical and haemodynamic evaluation. Calcium antagonists are probably the drug of choice. There are few studies about the effect of vasodilatory treatment of "secondary" pulmonary hypertension due to chronic lung diseases, with differing results. Whether vasodilatory treatment can improve the life expectancy in patients with primary or secondary pulmonary hypertension is not yet known. The quality of life seems, however, to be improved, at least in some patients.