Clinical InvestigationCongestive Heart DiseaseImpaired peripheral endothelial function in severe idiopathic pulmonary hypertension correlates with the pulmonary vascular response to inhaled iloprost
Section snippets
Patient population
The study was conducted between February 2004 and June 2005. During this period, all patients with pulmonary arterial hypertension hospitalized for treatment of pulmonary hypertension were screened for inclusion. They were eligible if they met the following criteria: (1) a diagnosis of IPAH with exclusion of pulmonary arterial hypertension secondary to other causes; (2) chronically stable disease with New York Heart Association class II/III; (3) mean pulmonary artery pressure (PAP) ≥30 mm Hg at
Results
Characteristics of patients with IPAH and those in the control group are outlined in Table I. Patients in the IPAH group tended to have lower diastolic blood pressure values as well as lower high-density lipoprotein cholesterol levels. As to the distribution of all other characteristics, the 2 groups showed similar patterns. Patients with IPAH showed a mean baseline systolic PAP of 81 mm Hg (95% CI 70-93 mm Hg), a diastolic PAP of 32 mm Hg (95% CI 26-39 mm Hg), and a mean PAP of 51 mm Hg (95%
Discussion
The present study has 2 major findings. The first is an association of IPAH with endothelial dysfunction in peripheral, nonpulmonary conduit vessels. Compared to controls, patients with IPAH exhibited impaired endothelium-dependent vasoreactivity, whereas the level of endothelium-independent vasoreactivity was similar in both groups. Except for diastolic blood pressure and high-density lipoprotein cholesterol levels, controls exhibited a pattern of cardiovascular risk factors resembling that of
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