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Antes Revista del Instituto Nacional de Enfermedades Respiratorias

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2006, Número 3

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Neumol Cir Torax 2006; 65 (3)


Iloprost en hipertensión pulmonar:Renacimiento de un viejo conocido

Campos CR, Rosas RMJR, Morales-Blanhir JE

Idioma: Español
Referencias bibliográficas: 59
Paginas: 132-145
Archivo PDF: 137.42 Kb.


RESUMEN

La hipertensión pulmonar se define como la presencia de presión pulmonar media mayor de 25 mmHg en reposo, o 30 mmHg durante el ejercicio, determinado durante el cateterismo cardiaco derecho. Descrita hace más de 100 años, en la actualidad persisten aún muchas preguntas acerca de su etiología, diagnóstico temprano y tratamiento. En el transcurso de los últimos 50 años, se han desarrollado diversas estrategias de diagnóstico y tratamiento que han modificado la evolución de la misma. La terapia con diuréticos, digitálicos y vasodilatadores iniciaron el camino; el estudio hemodinámico de estos pacientes permitió evaluar diferentes medicamentos y su influencia sobre la enfermedad. Los prostanoides y sus derivados demostraron mejorar la hemodinámica cardiopulmonar, sin los efectos deletéreos de los antagonistas de los canales de calcio, vasodilatadores venosos y arteriales utilizados.
Iloprost, un análogo de prostaciclina, se utilizó en un inicio como vasodilatador en la enfermedad vascular periférica, desde la década de los 80 demostró poseer actividad vasodilatadora pulmonar cuando se empleó por vía endovenosa. Posteriormente, se confirmó dicha actividad y se desarrolló la administración inhalada, demostrando mayor selectividad vascular pulmonar y mejoría en la función cardiopulmonar. Su efecto hemodinámico agudo, similar al óxido nítrico y prostaciclina, lo hace una herramienta útil en el diagnóstico y estratificación de los pacientes. Su administración a largo plazo, permite un control sostenido de la presión pulmonar, incrementa la calidad de vida y la tolerancia al ejercicio, mejorando así la clase funcional.
Actualmente se encuentra en estudio la terapia combinada con inhibidores de fosfodiesterasa e inhibidores de endotelina para el tratamiento a largo plazo de la hipertensión arterial, y así, modificar el espectro actual de la enfermedad.


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