The Dangers Of Pulmonary Hypertension
Treatments can help control symptoms and protect the heart.
Pulmonary arterial hypertension occurs when the arteries serving the lungs become stiff and thick. Blood pressure in the lungs rises, and the right side of the heart must work harder to pump blood to the lungs. Symptoms tend to mimic those of other more common diseases, so diagnosis is often delayed. As the overworked heart struggles to do its job, its right side gradually begins to fail.
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Role Of Oxidative Stress In The Lungs And Pulmonary Vasculature In Pulmonary Hypertension
Oxidative stress occurs when the number of reactive oxygen species exceeds that which the biological system can combat and neutralize. ROS are oxygen containing molecules with an odd number of electrons, termed free radicals. These free radicals can oxidize molecules, such as lipids and DNA, causing a multitude of harmful effects. The pulmonary vasculature undergoes morphological changes in PH that can be mediated by oxidative stress. Past research has shown the expression of various oxidative stress markers changes in the lungs and pulmonary vasculature of animals and humans with PH.
Bertoli et al. investigated the effects of chronic iron-overload on the resistance pulmonary arteries in rats. They found that rats treated with a high dose of iron dextran demonstrated increased vasoconstriction and vascular hyper-reactivity and reduced NO which were reversed by antioxidant therapy . Hoshikawa et al. found that the free radical phosphatidylcholine hydroperoxide increased within 7 days following hypoxic exposure in rat lungs, and treating the rats with antioxidant N-acetylcysteine resulted in suppression of lung PCOOH levels. The activity of xanthine oxidase , an enzyme that generates ROS, was also increased in rat lung tissue over time from day 1 through day 21 of hypoxia. Treating rats with the XO inhibitor allopurinol significantly inhibited the hypoxia-induced PH and resulted in decreased lung PCOOH levels .
How Pulmonary Hypertension Affects Your Body
Oxygen-poor blood returning to the heart from all body organs and tissues travels from the right side of the heart through the pulmonary arteries into the lungs. Within the lungs, these arteries divide into smaller vessels in order to take in oxygen and get rid of carbon dioxide. The oxygen-rich blood then returns to the left side of the heart from where it is pumped back to all body organs and tissues.
Normally, the blood flows relatively easily through these vessels in your lungs but in PH, the walls of the arteries become stiff, damaged and narrow. This makes blood flow much more difficult and causes the blood pressure in the lungs to rise and the right side of your heart to work harder. Over time, this added stress to the right side of your heart can lead to other medical problems, specifically heart failure.
Pulmonary hypertension is classified by the World Health Organization according to its causes or associated underlying conditions:
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Past Failures Of Antioxidant Ph Therapies In The Rv And Lungs
A variety of antioxidant therapies have been tested for the treatment of pre-clinical PH. Some studies have focused on targeting oxidative stress in the lungs, whereas others have focused more on the effects of antioxidant therapies in the RV. RV failure is the primary cause of death in PH patients, and although treatment of patients with vasodilator antioxidants may reduce pulmonary vascular resistance, this effect may not be accompanied by improvements in the RV .
The use of continuous inhalation of NO as a treatment was also used in a study of rats exposed to chronic hypoxia followed by normoxia, but there was no effect on alleviating pulmonary vascular remodeling in the PH lungs . Prior studies on the umbilical vein endothelial cells led to the belief that NO can decrease malignant ET-1 overexpression which in theory should minimize the effects of oxidative stress. However, in a group of rats with hypoxia induced PH, investigators found that NO had no impact on the increased ET-1 expression in rat lungs with PH induced by hypoxic conditions .
To summarize, although antioxidants have shown promise in the treatment of experimental PH and RV failure, there have been reports of failure of some of these therapies. Understanding the precise role of oxidative stress in the pathogenesis and progression of PH and RV failure will help in developing targeted and effective antioxidant therapies.
While Theres No Cure For Pah There Are Effective Ways To Manage The Disease
The median survival used to be 2.5 years. Now I’d say most patients are living seven to 10 years, and some are living as long as 20 years.
Alessandro Maresta. M.D., Vice President and Head of Global Medical Affairs, Actelion PharmaceuticalsShare
On a physiological level, there are several different biological mechanismsknown as pathwaysrelated to how blood vessels work that are believed to play a role in PAH.
“The guidelines strongly recommend that when a patient is diagnosed with PAH, they start a combination of drugs to target two different pathways,” Maresta says. “You might get one drug first, and then start on the second one within six months.” Maresta adds that current studies are now suggesting that targeting three pathways at once has the potential to lead to better outcomes.
While there’s currently no cure for PAH, the typical prognosis is much better today than it was 25 years ago. “The median survival used to be 2.5 years,” Maresta says. “Now I’d say most patients are living seven to 10 years, and some are living as long as 20 years.”
The main focus today, adds Maresta, is to find a new pathway and an effective drug to target itfor which research is currently underway. “We’re dedicated to making it happen,” Maresta says.
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Group 5 Pulmonary Hypertension
Group 5 includes pulmonary hypertension triggered by other disorders. Examples of such diseases or conditions are blood disorders such as polycythemia vera and essential thrombocythemia systemic disorders such as sarcoidosis and vasculitis metabolic disorders such as thyroid and glycogen storage disease and other conditions such as kidney disease and tumors that press on the pulmonary arteries.
Can Anxiety Cause High Blood Pressure
According to the Anxiety & Depression Association of America , anxiety disorders affect more than 40 million adults every year in the United States. Anxiety can cause a wide range of physical symptoms, including an increase in blood pressure levels.
Although anxiety isnt linked to chronic high blood pressure, both short-term and chronic anxiety may cause your blood pressure to spike.
In this article, well explore the link between anxiety and high blood pressure and treatment options for both.
doesnt cause chronic high blood pressure. However, it can lead to a short-term increase in blood pressure.
When you begin to feel anxious because of a stressful situation, your body enters fight-or-flight mode. This happens due to the activation of your sympathetic nervous system. During fight-or-flight mode, your adrenaline and cortisol levels rise, both of which can lead to an increase in blood pressure.
Although stress and anxiety can cause high blood pressure, its only temporary, and levels generally return to normal once youve calmed down again.
High blood pressure, or hypertension, is a chronic condition that occurs when blood pressure levels are elevated. Chronic high blood pressure can be quite dangerous and can cause significant damage to the body, especially the brain, heart, kidneys, and eyes.
Hypertension is classified into two categories:
Treatment options that may help include:
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Cardiopulmonary Exercise Testing And Echocardiography
At baseline, a symptom-limited exercise test was performed during supine bicycle exercise as described previously . The exercise testing began at 25 Watt with a stepwise increment of 25 W every two minutes. Systolic pulmonary artery pressure , systolic and diastolic systemic blood pressures, Work load, heart rate, minute ventilation , oxygen uptake , oxygen pulse , and oxygen saturation were measured continuously. The anaerobic threshold was determined using the V-Slope method . Peak VO2 was defined as the highest 30-second average value of oxygen uptake during the last minute of the exercise test. Borg dyspnea index was inquired immediately after the test. Two-dimensional and Doppler-echocardiographic recordings were performed immediately before and during the cardiopulmonary exercise testing using 2.5 MHz Duplex probes and conventional equipment by experienced cardiac sonographers.
Drugs For Pulmonary Hypertension
Several drugs, either in isolation or in combination with each other, can support the management of pulmonary hypertension. For example:
- Diuretics: These help a person reduce fluid retention and swelling. They are also known as water pills.
- Digoxin: A person can use these to manage heart failure. Digoxin helps control heart rate and rhythm and increases the amount of blood that the heart can pump with each heartbeat.
- Blood thinning drugs such as warfarin: These can help reduce the risk of blood clots, which are more likely in people with pulmonary hypertension.
- Calcium channel blockers such as diltiazem: These help the blood vessels widen to improve blood flow.
- Phosphodiesterase-5 inhibitors: These also increase blood flow by making blood vessels wider. Sildenafil is one example of a PDE5 inhibitor.
- Endothelin receptor antagonists such as bosentan and ambrisentan: These limit the constriction of arteries that can develop when a person has too much natural peptide.
Inhaled options, such as iloprost or treprostinil , can help relieve breathlessness.
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Adapting And Moving Forward
The first step toward moving forward is recognizing that your life has changed and that the way you handle stress may have to change as well. Most people living with PH learn to manage stress better over time by developing coping strategies that tend to their mind, body and spirit. What follows are a variety of coping methods that have worked for others. Stress is very subjective what causes stress in one person may bring joy and pleasure to another. What relieves stress also differs from person to person. Dont be afraid to explore a few stress relief techniques before settling into a routine that fits for you and your situation.
Expect the Unexpected
It may seem counter-intuitive, but one way of coping with stress is by learning to accept its inevitable presence in your life. Even the most laid-back among us encounter occasional frustrations. Rather than trying to eliminate stress entirely, accept that youll face some unexpected hurdles every day. Some of these challenges may be everyday annoyances and some may be much larger obstacles. However, if you can adjust your thinking to acknowledge that challenges are bound to present themselves, its easier to interpret potentially stressful situations as challenges to be overcome or changes to be accepted. Learning to accept those things you can control and to let go of those that are outside of your control can make it easier to move forward when things break down, fall apart, or deviate from schedule.
Be Good to Your Body
The Exact Cause Of Pah Is Unknown But Physiological Changes Are Key To Its Development And Progression
PAH is diagnosed when mean, or average, blood pressure leaving the arteries on the right side of the heart is measured at 25 mmHg or higher. No one knows exactly what kicks off the chain of events that sets PAH in motion, but experts do know a lot about how it progresses.
“It starts with constriction of these vessels and leads to remodeling of the vessel wall,” says Alessandro Maresta, M.D.Alessandro Maresta, M.D.,Vice President and Head of Global Medical Affairs, Actelion Pharmaceuticals, Vice President and Head of Global Medical Affairs for Actelion Pharmaceuticals, a Swiss biotech company that Johnson & Johnson acquired in June of this year. “As the walls of the blood vessels thicken, the lumenthe space where blood flows throughgets smaller, and the pressure goes up. As the disease progresses, pressure continues to rise, but the right ventricle of the heart is not designed to pump blood against such high pressure.”
As the condition worsens, “patients tend to become very tired and short of breath,” says Nazzareno Galié, M.D., professor of cardiology and Director of the Specialization School of Cardiology, University of Bologna, Italy. “Some people might notice heart palpitations or feel chest pressure, especially when exercising.”
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Assessment Of Mental Disorders Using Phq
Both questionnaires were self-completed by the patient in written form and refer to the symptoms of the patients within the last 2 weeks.
The Patient Health Questionnaire was developed in 1999 as a self-reporting questionnaire allowing a criteria-based diagnosis of depression in primary care . PHQ-9 had an excellent reliability and validity for the diagnosis of depression and consists of the nine diagnostic criteria items measuring the severity of depressive symptoms . Spitzer et al. recommended categorizing the PHQ-9 total score into four severity groups: no symptoms of depressive/anxiety disorders , mild , moderate , severe symptoms. For our study we divided the groups in 1) none-mild depression using the cut-off score of 9. Members group 2) with moderate to severe depression had the score 10.
The generalized anxiety disorder questionnaire is a self-reporting questionnaire to diagnose anxiety using 7 diagnostic items . The diagnostic score of each item of the questionnaire ranges from 0 to 3 . To estimate the severity of symptoms the total summation score ranges from 0 to 21. The PHQ-9 is divided into minimal , mild , moderate and severe anxiety. The questionnaire has a high reliability and validity for the diagnosis of major depression . For our study we divided the groups in 1) none-mild anxiety using the cut-off score of 9. Members of group 2 with moderate to severe anxiety had the score 10.
What Causes Pulmonary Hypertension
Some common underlying causes of pulmonary hypertension include high blood pressure in the lungs arteries due to some types of congenital heart disease, connective tissue disease, coronary artery disease, high blood pressure, liver disease , blood clots to the lungs, and chronic lung diseases like emphysema. Genetics also play a role.
Pulmonary hypertension can happen in association with many other diseases, such as lung disease and heart disease. Heart failure is common in pulmonary hypertension.
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High Blood Pressure Is More Common During Anxiety Attacks
Hypertension can affect any individual, and it has several risk factors however, it is quite common with those suffering from anxiety attacks, as stress and anxiety causes a rapid rise in blood pressure.
It’s important to monitor your hypertension. But it’s also important to trust your doctor, and recognize that:
- Not all hypertension is caused by anxiety.
- Anxiety does not always cause hypertension.
You’re likely aware of the former. Hypertension is a natural part of aging and diet. It’s something you should monitor and try to control, but it’s also something that cannot always be controlled easily.
What you may not be aware of is that anxiety itself – a condition that is associated with extreme stress – doesn’t always cause hypertension, even when you’re anxious. That’s because when a healthy person with normal blood pressure experiences anxiety for an extended period of time , the body actually adjusts your blood pressure levels to account for the anxiety. So while anxiety can cause hypertension initially, chronic anxiety is considered unlikely to cause hypertension after the body adjusts to it.
Right Ventricular Failure Secondary To Chronic Pulmonary Hypertension
Right ventricular function is the leading prognostic determinant of survival in PH patients. For example, 5-year survival in patients with pulmonary arterial hypertension is strongly correlated with RV ejection fraction compared to pulmonary artery pressures or pulmonary vascular resistance . However, there is no true definition for right ventricular failure as it clinically varies from case to case and the therapeutic options for RVF are very limited. Recently, the American Thoracic Society defined RVF as âa complex clinical syndrome characterized by insufficient delivery of blood from the RV in the setting of elevated systemic venous pressure at rest or exercise.â This widespread phenomenon is a direct result of RV hypertrophy as the overworked myocytes experience increased afterload and lose their contractility . While RV hypertrophy is just the initial compensatory mechanism for high pulmonary vascular pressures, RVF takes effect once the hypertrophy becomes maladaptive.
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Saphire: Stress And Pulmonary Hypertension In Rheumatoid Evaluationa Prevalence Study
G. E. M. Reeves
1John Hunter Hospital, University of Newcastle, Callaghan, NSW 2308, Australia
2Department of Cardiology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
3Autoimmune Resource and Research Centre, New Lambton Heights, NSW 2305, Australia
4Pathology North, New Lambton Heights, NSW 2305, Australia
Pulmonary artery hypertension is a disorder of elevated resistance in the pulmonary arterial vessels, reflected by elevation of measured pulmonary artery pressure , and presenting with breathlessness and, if untreated, progressing to right heart failure and death. The heightened prevalence of PAH in populations with underlying systemic autoimmune conditions, particularly scleroderma and its variants, is well recognised, consistent with the proposed autoimmune contribution to PAH pathogenesis, along with disordered thrombotic, inflammatory, and mitogenic factors. Rheumatoid arthritis is one of a group of systemic autoimmune conditions featuring inflammatory symmetrical erosive polyarthropathy as its hallmark. This study explored the prevalence of PAH in a population of unselected individuals with RA, using exercise echocardiography . The high prevalence of EchoCG-derived elevation of PAP in this population suggests that, like other autoimmune conditions, RA may be a risk factor for PAH. Patients with RA may therefore represent another population for whom PAH screening with noninvasive tools such as EchoCG may be justified.