Diltiazemの肺高血圧症に対する有用性

The effect of diltiazem in the patients with pulmonary hypertension

　肺高血圧症の治療に対し，これまで種々の薬剤の投与が試みられてきた。しかし，如何なる症例に対しても満足のいく治療効果を得ることのできた薬剤は見当らず，肺高血圧症の治療は困難を極めている。特に重症肺高血圧症に対しては，今なお手の施しようがなく，より有用な治療薬の探索が急がれている。

　近年，肺高血圧症では肺血管の攣縮^1）を伴うことが報告され，カルシウム拮抗剤がその治療薬として注目されるようになってきた。なかでも，verapamil^2），nifedi—pine^3,4）についてはここ数年治療効果の検討が進められ，有効例がしばしば報告されている。しかし，その効果については両薬剤とも現時点では自覚症状の一時的な改善以上の期待はできない。

The role of pulmonary vasospasm on the pathoge-nesis of pulmonary hypertension has been observed.

Various kinds of vasodilators have been applied so far for the treatment of pulmonary hypertension. Especially recent attention has been focused on cal-cium channel blockers, however, the results are not satisfactory.

We have administered diltiazem, to the patients suffering from severe pulmonary hypertension even with various trial of vasodilators such as hydralazine captopril and nifedipine. Before the treatment with diltiazem, two cases with primary pulmonary hy-pertension and two cases with secondary pulmonary hypertension due to atrial septal defect had been in the cardiac function of NYHA class III or IV. The administration of diltiazem has resulted in remarkable improvement both symptoms and signs. Bradycardia was observed in two cases, which was swiftly improved in accordance with decreasing dose.

These results indicated that diltiazem was one of the useful drugs for the treatment of severe pulmo-nary hypertension of primary as well as secondary.