Introduction: What is pulmonary hypertension?
When we talk about pulmonary hypertension, we are actually talking about high blood pressure, which only occurs in the lungs. Similar to normal high blood pressure (whereby the blood pressure is elevated in the entire body circulation), there are many causes for a change in blood pressure. This affects breathing and also has a negative effect on the heart – especially the right side of the heart. Overall, pulmonary hypertension is a rare disease.
What are the causes of pulmonary hypertension?
The causes of pulmonary hypertension are manifold. The frequency of each cause depends primarily on the age of the person affected. In older people, pulmonary hypertension is usually caused by weakness in the left half of the heart.
As a result, the heart can no longer pump blood well into the body, causing it to back up in the lungs. As a result, blood is virtually congested there, causing high blood pressure in the lungs. Many diseases of the lung tissue, such as COPD (chronic obstructive pulmonary disease), can also cause pulmonary hypertension.
Changes in the tissue also affect the blood vessels in the lungs, which can lead to pulmonary hypertension. In younger people, pulmonary hypertension often has a genetic component. This means that the predisposition to it can be inherited.
This is due to various mutations in certain genes that regulate the resistance in the pulmonary vessels. Misregulation due to a mutation can lead to increased blood pressure in the lungs. People born with a heart defect are also more likely to suffer from pulmonary hypertension.
This is due to the changed blood flow conditions, which can lead to overloading of both the left and right side of the heart. This causes the blood to congestion in the lungs, leading to pulmonary hypertension. Even small blood clots, which settle in the pulmonary vessels, can cause pulmonary hypertension.
How to treat pulmonary hypertension
The treatment of pulmonary hypertension initially depends on whether there is an underlying disease that can be treated. If, for example, heart failure or a disease of the lung tissue is the trigger of pulmonary hypertension, these diseases should be treated first before a specific therapy has to be initiated. The drug treatment of pulmonary hypertension consists of a combination of drugs that dilate the blood vessels in the lungs and reduce minor inflammation in the lungs.
Water tablets can also be used to minimize water retention. There are also special sports rehabilitation programs designed to improve physical performance. In addition, affected smokers should stop smoking, and weight reduction for overweight people can also improve the symptoms.
The only curative (curative) therapy is surgery. If small blood clots are the cause of pulmonary hypertension, they can be removed by surgery. In the hereditary or idiopathic form, a heart-lung transplant is often the only chance of cure.
Special medications for pulmonary hypertension are characterized by their vasodilating effect. If a positive vasoreactivity test is available, pulmonary hypertension is reduced particularly strongly with the administration of nitric oxide (NO). This is because the vasoreactivity test tests whether nitric oxide leads to success in dilating the blood vessels.
In this case, calcium channel blockers such as amiodarone can be used. Other drugs act directly on the vessel walls, such as the endothelin receptor antagonists (ambrisentan, bosentan, macitentan). PDE-5 inhibitors such as sildenafil and the drug riociguat have a vasodilating effect by interfering with the metabolism of nitric oxide.
