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The burden of comorbidities in pulmonary arterial hypertension

Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (sy...

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Autores principales: Lang, Irene M, Palazzini, Massimiliano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915052/
https://www.ncbi.nlm.nih.gov/pubmed/31857797
http://dx.doi.org/10.1093/eurheartj/suz205
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author Lang, Irene M
Palazzini, Massimiliano
author_facet Lang, Irene M
Palazzini, Massimiliano
author_sort Lang, Irene M
collection PubMed
description Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities.
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spelling pubmed-69150522019-12-19 The burden of comorbidities in pulmonary arterial hypertension Lang, Irene M Palazzini, Massimiliano Eur Heart J Suppl Articles Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities. Oxford University Press 2019-12 2019-12-17 /pmc/articles/PMC6915052/ /pubmed/31857797 http://dx.doi.org/10.1093/eurheartj/suz205 Text en Published on behalf of the European Society of Cardiology. © The Author(s) 2019. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Articles
Lang, Irene M
Palazzini, Massimiliano
The burden of comorbidities in pulmonary arterial hypertension
title The burden of comorbidities in pulmonary arterial hypertension
title_full The burden of comorbidities in pulmonary arterial hypertension
title_fullStr The burden of comorbidities in pulmonary arterial hypertension
title_full_unstemmed The burden of comorbidities in pulmonary arterial hypertension
title_short The burden of comorbidities in pulmonary arterial hypertension
title_sort burden of comorbidities in pulmonary arterial hypertension
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915052/
https://www.ncbi.nlm.nih.gov/pubmed/31857797
http://dx.doi.org/10.1093/eurheartj/suz205
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