Bhagwat P. Mane, Balaji R. Ajgunde, Shyamlila B. Bavage, Nandkishor B. Bavage
large variety of drugs is available for treatment of hypertension. Moreover, many randomised controlled trials with clinically relevant endpoints (morbidity, mortality, quality of life) do exist in the cardiovascular field, providing for sufficient evidence to choose the appropriate agent in most circumstances. For diuretics and betablockers a large body of evidence in terms of beneficial effects on outcome does exist, for ACE-inhibitors in some special indications only. These drugs are therefore recommended as first-line treatments. For calcium-channel blockers (with the exception of isolated systolic hypertension in the elderly) and AT1-receptor-antagonists the results of endpoint-studies are still awaited. These results will have to be considered for revised versions of currently available guidelines. Pulmonary arterial hypertension (PAH) is a progressive and debilitating disease characterized by a pathological increase in the resistance of the pulmonary circulation . The increased pulmonary vascular resistance (PVR) leads to right ventricular dysfunction, exertional impairment, and premature death . The United States national prospective registry for primary pulmonary hypertension reported the median survival for the idiopathic form of PAH to be only 2.8 years without treatment . Two meta-analyses have reviewed the treatments of PAH . A meta-analysis by Macchia et al in 2007 included some patients with non-PAH pulmonary hypertension and the results of several trials have been reported since this publication . A meta-analysis by Galiè et al published in 2009 concluded that PAH treatment improved mortality, however this conclusion is limited by the pooling of all three classes of PAH treatment and the inclusion of multiple doses of medication, some of which are not approved for clinical use due to either increased adverse effects or lack of efficacy . The failure to include unpublished data in this meta analysis may have also introduced a publication bias. We sought to improve upon these previous meta-analyses by addressing these issues. By pooling the available literature, we sought to determine the effect of these classes of medication on total mortality and secondarily to assess their impact on other cli
Article Details
Unique Paper ID: 152407

Publication Volume & Issue: Volume 8, Issue 3

Page(s): 210 - 216
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