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The review is devoted to modern pharmaceutical treatment of pulmonary arterial hypertension (PAH). In 1970-80s, it was based on high-dose calcium antagonists, CA (e.g., nifedipine 240 mg/d), which were effective only in some patients with primary (idiopathic) PAH. CA were combined with digoxin, indirect anticoagulants and oxygen. In 1990s, PAH therapy included prostanoids, endothelin receptor (ER) blockers and phosphodiesterase (PDE) inhibitors, which are more selective pulmonary vasodilatators than CA, and therefore are safer for long-term treatment. Prospective studies have demonstrated that continuous intravenous infusion of epoprostenol and ET receptor blocker bosentan treatment improve survival of PAH patients receiving traditional therapy. Clinical effectiveness of epoprostenol is similar to that of subcutaneously administered trepostinil, and bosentan is similar to PDE inhibitor Type 5 sildenafil. Bosentan increases the effectiveness of intravenous epoprostenol and inhaled trepostinil

The review is devoted to modern pharmaceutical treatment of pulmonary arterial hypertension (PAH). In 1970-80s, it was based on high-dose calcium antagonists, CAs (e.g., nifedipine 240 mg/d), which were effective only in some patients with primary (idiopathic) PAH. CAs were combined with digoxin, indirect anticoagulants and oxygen. In 1990s, PAH therapy included prostanoids, endothelin receptor (ER) blockers and phosphodiesterase (PDE) inhibitors, which are more selective pulmonary vasodilatators than CAs, and therefore are safer for long-term treatment. Prospective studies have demonstrated that continuous intravenous infusion of epoprostenol and ET receptor blocker bosentan treatment improve survival of PAH patients receiving traditional therapy. Clinical effectiveness of epoprostenol is similar to that of subcutaneously administered trepostinil, and bosentan is similar to PDE inhibitor Type 5 sildenafil. Bosentan increases the effectiveness of intravenous epoprostenol and inhaled trepostinil.

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. The twelfth communication contains consideration of inhaled nitrous oxide and three available inhibitors of phosphodiesterase type 5 (sildenafil, tadalafil, and vardenafil). The place of nitrous oxide in diagnostics and short term treatment of PAH is discussed.Analysis,of results of randomized controlled studies assessing efficacy and safety of sildenafil inpatients with primary (idiopathic) PAH an PAH associate wit connective tissue diseases and congenital heart diseases with systemic-to-pulmonary shunts is presented.

The review presents literature data on the key role of platelet aggregation (PA) for intracoronary thrombogenesis in various acute coronary syndromes (ACS) and percutaneous coronary interventions (PCI). Clinical pharmacology of main antiplatelet medication (APM) classes is discussed, with emphasis on a new APM class - blockers (inhibitors) of IIb/IIIa glycoprotein receptors (GP IIb/IIIa). The authors analyse the results of randomized clinical trials on effectiveness and safety of abciximab, tirofiban, and eptifibatide in non-ST ACS and planned or urgent PCI. Clinical situations and other factors determining the choice of specific GP IIb/IIIa blocker are discussed.