SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

A Change of Attitude in the Treatment of Pulmonary Arterial Hypertension

█ Current opinion

Karlócai Kristóf1, Ablonczy László2, Ágoston Gergely3,4, Bálint Olga Hajnalka2, Csósza Györgyi1, Daragó Andrea5, Faludi Réka6, Forster Tamás4, Péter Andrea5, Temesvári András2, Varga Albert3,4
1Semmelweis Egyetem, Pulmonológiai Klinika, PAH centrum, Budapest, MKT/MTT Kardiopulmonalis Munkacsoport
2Gottsegen György Országos Kardiológiai Intézet
3Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, II-es számú; Belgyógyászati Klinika és Kardiológiai Központ
4Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Családorvosi Tanszék
5Debreceni Egyetem Klinikai Központ, Kardiológiai és Szívsebészeti Klinika, Debrecen
6Pécsi Tudományegyetem, Klinikai Központ, Szívgyógyászati Klinika, Pécs


The current Hungarian financing protocol still sets the level of the 2009 European PAH Recommendation, so it is outdated and should be renewed. Evaluation and treatment should be performed in specific PAH centers. In stepwise evaluation, the next test depends on the outcome of the previous step. Invasive catheterization is still required, but the vasoreactivity test is limited on the forms, where vasoreactivity is expected. Therapy depends on the type of PAH disease, the degree of risk, and whether it is a new patient or an existing patient. Combination treatments have come to the forefront of treatment. In the high-risk patients with the classic form immediate iv. prostacyclin should be started and combined with oral agents, this may result in a dramatic risk reduction. A triple combination with an oral prostacyclin receptor agonist is also recommended in previously treated but still at moderate risk patients, but parenteral prostacyclines are recommended when the risk is high. Acute right ventricular failure in PAH requires the administration of prostacyclines, which should be confirmed after the acute course.


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