Journal
AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY
Volume 314, Issue 6, Pages L967-L983Publisher
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/ajplung.00553.2017
Keywords
drug-induced pulmonary hypertension; pathology; pharmacovigilance; prevention
Categories
Funding
- National Institutes of Health (NIH) [R01-HL-134776, R01-HL-134776-02]
- Pulmonary Fibrosis Foundation
- Pulmonary Hypertension Association
- NIH [NHLBI-HV-10-05, 1U01-HL-107393-01, PAR-09-185, N01-HV-00242, R01-DA-034542, R01-DA-042715 02, 5 R01-HL-129875-02]
- Vera Moulton Wall Center
- American Heart Association Scientist Development Award
- Parker B. Francis Fellowship Award
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Drug-induced pulmonary arterial hypertension (D-PAH) is a farm of World Health Organization Group 1 pulmonary hypertension (PH) defined by severe small vessel loss and obstructive vasculopathy, which leads to progressive right heart failure and death. To date, 16 different compounds have been associated with D-PAH, including anorexigens, recreational stimulants, and more recently, several Food and Drug Administration-approved medications. Although the clinical manifestation, pathology, and hemodynamic profile of D-PAH are indistinguishable from other forms of pulmonary arterial hypertension, its clinical course can be unpredictable and to some degree dependent on removal of the offending agent. Because only a subset of individuals develop D-PAH, it is probable that genetic susceptibilities play a role in the pathogenesis, but the characterization of the genetic factors responsible for these susceptibilities remains rudimentary. Besides aggressive treatment with PH-specific therapies, the major challenge in the management of D-PAH remains the early identification of compounds capable of injuring the pulmonary circulation in susceptible individuals. The implementation of pharmacovigilance, precision medicine strategies, and global warning systems will help facilitate the identification of high-risk drugs and incentivize regulatory strategies to prevent further outbreaks of D-PAH. The goal for this review is to inform clinicians and scientists of the prevalence of D-PAH and to highlight the growing number of common drugs that have been associated with the disease.
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