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Step 1
Administer vasodilators and anticoagulants for primary pulmonary hypertension. These treatments have only a 25 to 35 percent response rate and this form of the disease is progressive with no cure. Cases of spontaneous remission have been reported but this is extremely rare.
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Step 2
Begin vasodilator therapy primarily for the purpose of decreasing the pulmonary vascular resistance. Little evidence exists to show that vasodilators will improve the overall clinical picture in the long term.
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Step 3
Use calcium channel blockers mostly for short-term improvements. Longer-lasting calcium channel blockers such as the dihydropuridines and diltiazem produce an improvement in 20 to 30 percent of patients. Verapamil is not used because of its negative inotropic effects.
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Step 4
Provide anticoagulation therapy for patients at high risk for thromboembolism. Anti-coagulation therapy in combination with warfarin has been shown to prolong the life of individuals with primary pulmonary hypertension.
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Step 5
Address the underlying cause of secondary pulmonary hypertension. This form of the disease is associated with hypoxic vasoconstriction, which should be treated with oxygen. Pulmonary embolisms are the most common cause of secondary pulmonary hypertension and may be treated with anticoagulants.
