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Communications to the Editor |

Epoprostenol and Nesiritide in Pulmonary Hypertension FREE TO VIEW

Lewis J. Rubin, MD, FCCP
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La Jolla, CA

Correspondence to: Lewis J. Rubin, MD, FCCP, Professor of Pulmonary and Critical Care Medicine, UCSD Medical Center/Thornton, 9300 Campus Point Dr, MC 7372, La Jolla CA 92037-130; e-mail: ljrubin@ucsd.edu



Chest. 2005;127(5):1870. doi:10.1378/chest.127.5.1870
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To the Editor:

The case report by Kurian et al1highlights several important misconceptions regarding the management of pulmonary hypertension that warrant attention. Firstly, one cannot address the optimal approach to therapy of pulmonary hypertension without first delineating its etiology. In the case presented, the disease process was postcapillary in origin, and therefore should have been treated as such. Although the authors refer to epoprostenol (prostacyclin) as “traditional therapy,” this drug is approved by the Food and Drug Administration for the treatment of patients with pulmonary arterial hypertension (PAH) who fall in to New York Heart Association functional classes III or IV; indeed, epoprostenol therapy is considered to be contraindicated in patients with pulmonary venous hypertension due to left-sided heart disease.2 At best, this would have to be considered off-label use that carries considerable risk without evidence of benefit for this condition.

Whether nesiritide may offer benefit in patients with PAH will require carefully performed clinical trials in a well-defined population using established criteria for disease definition. The current management of patients with PAH is presented comprehensively in the American College of Chest Physicians evidence-based guidelines, which accompanied the July issue of CHEST.3

Kurian, DC, Wagner, IJ, Klapholz, M (2004) Nesiritide in pulmonary hypertension.Chest126,302-305. [CrossRef] [PubMed]
 
Physicians’ desk reference 57th ed.,1516-1520 Thompson. Montvale, NJ:
 
Diagnosis and management of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.Chest2004;126(Suppl),1S-92S
 

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References

Kurian, DC, Wagner, IJ, Klapholz, M (2004) Nesiritide in pulmonary hypertension.Chest126,302-305. [CrossRef] [PubMed]
 
Physicians’ desk reference 57th ed.,1516-1520 Thompson. Montvale, NJ:
 
Diagnosis and management of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.Chest2004;126(Suppl),1S-92S
 
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