Pulmonary Arterial Hypertension: Current Therapeutic Strategies

Choice of Therapy

The decision of which agent to use is largely dependent on the severity of PAH at presentation and, to some extent, on patient preference. In patients who are WHO functional class I-II at presentation, an oral agent, such as an endothelin-receptor antagonist or phosphodiesterase inhibitor, is usually an appropriate first choice and often results in symptomatic improvement. For patients who present with evidence of right heart failure or right ventricular dysfunction, a parenteral agent (typically epoprostenol or a prostacyclin analog) can be appropriate, but the initiation of oral agents should also be considered. Increasingly, many patients are hesitant to consider a parenteral agent in the face of available oral agents; however, no long-term data exist regarding the use of the oral agents in patients with severe right ventricular dysfunction.Previous PageSection 7 of 10 Nat Clin Pract Cardiovasc Med. 2007; 4(6):319-329. ©2007  Nature Publishing Group
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