Vasodilators

Vasodilators are medications that cause widening or relaxation of blood vessel walls. They are used to treat primary pulmonary hypertension by widening the arteries, allowing blood to flow through more easily, and reducing blood pressure. This is essential because high blood pressure puts a burden on the heart and the arteries, and can lead to permanent damage over time. If untreated, high blood pressure increases the risk of heart attacks, heart failure, stroke, or kidney failure. Vasodilators usually are prescribed with other types of blood pressure drugs and rarely are used alone.

Examples of vasodilators include Bosentan (Tracleer), Eporprostenol (Flolan), Treprostinil (Remodulin) and calcium channel blockers. Vasodilators have been shown to prolong and significantly improve the lives of people suffering from primary pulmonary hyperextension. Unfortunately, however, vasodilators are helpful to only 25% of all pulmonary hypertension patients. The other 75% are believed to be non-responders and some may even get worse if treated with vasodilators.

The vasodilator Bosentan works by blocking the hormone endothelin, which becomes more abundant in cases of Primary Pulmonary Hypertension. This increased concentration of endothelin is thought to be a possible cause of PPH because it narrows blood vessels and elevates blood pressure. By reducing the endothelin level, Bosentan reverses this effect and assists blood flow. Of the vasodilators it is considered the least invasive.

The vasodilator Flolan (epoprostenol) is a form of a molecule naturally produced by the body called Prostacyclin. Prostacyclin acts as an inhibitor of platelet aggregation, the process in which platelets combine at the site of vascular injury to block blood flow. It is believed that an abnormally low ratio of prostacyclin in relation to thromboxane A2, a molecule that stimulates platelet aggregation, may be partially responsible for the development of primary pulmonary hypertension. Prostacyclin analogs (imitators) such as Flolan have been used to treat Primary Pulmonary Hypertension and so far seem to support this belief.

The vasodilator Remodulin (Treprostinil sodium), a synthetic stable form of prostacyclin, might be a viable alternative for patients suffering from complication as a result of Flolan use. Remodulin lasts longer than Flolan and can be infused subcutaneous (under the skin). This method of infusion greatly reduces the risk of sepsis infection and hospitalization. However, Remodulin is still being used only on in clinical trials and unlike Flolan has not yet been approved by the FDA.

Calcium channel blockers (also called calcium antagonists) are vasodilators designed to prevent the entry of calcium ions into the muscle cells of the heart and blood vessels, causing these vessels to widen and relax. As a result, blood pressure is lowered and circulation is improved. Although there are many vasodilators (drugs that relax blood vessels) used to treat PPH, calcium channel blockers have been the most widely tested, and appear to be more effective than other vasodilators. Nevertheless, they are still only 20% effective in adults and 40% effective in children.

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