The effect of isosorbide dinitrate on the pulmonary arterial system in patients with pulmonary hypertension Tatsuo Hoshino 1 , Shunnosuke Handa 1 , Satoshi Akizuki 1 , Shingo Hori 1 , Hidemi Norisue 2 , Akiko Hori 2 , Toshio Fukui 2 1Cardiopulmonary Devision, Dept. of Internal Medicine, School of Medicine, Keio University 2Dept. of Medicine, Kawasaki Municipal Ida Hospital pp.291-295
Published Date 1981/3/15
DOI https://doi.org/10.11477/mf.1404203738
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The effect of isosorbide dinitrate (ISDN) on the pulmonary arterial system was evaluated with cardiac catheterization in 8 patients with heart diseases, 10 with chronic pulmonary diseases and 4 subjects without cardiopulmonary disease. Fif-teen of 22 patients had pulmonary hypertension (PH), with mean pulmonary arterial pressure be-tween 17 mmHg and 42 mmHg. They included 9 patients with precapillary and 6 patients with postcapillary PH. Pressures in right atrium, pul-monary artery and pulmonary capillary wedge position and pulmonary blood flow (PBF) were measured. Pulmonary arteriolar resistance (PAR), pulmonary arterial compliance (PAC) and pulmo-nary artery time constant were calculated, based of the alternating current theory by Engelberg and DuBois. Five mg of sublingual ISDN were given and 15 min later with maximum effect on hemodynamics, recording were repeated. The pressures were decreased significantly. The mean pulmonary arterial pressure in patients with PH decreased more than it in patients without PH. PBF in patients without PH was reduced, though it in patients with PH did not change. Accord-ingly, PAR was decreased in patients with PH, while did not change in those without PH. In patients with chronic pulmonary disease, arterial hypoxia did not change. We concluded, ISDN was useful for the treatment of precapillary and postcapillary PH. Right ventricular afterload decreased, as well as preload. In patients with low preload, however, ISDN might develop sys-temic hypotension as an adverse reaction. The change in PAR suggested active change in tone of the muscular pulmonary arteries, though the decrease in PAC was passive and related with decrease in pulmonary arterial pressure.

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