Pulmonary hypertension is a disease characterized by a disproportionate increase in pulmonary vascular resistance, concomitant with pathophysiological changes and decrease in the diameter of the pulmonary vessels. This results in an increase of work for the right heart, which eventually undergoes hypertrophy and failure. Over the last twenty years the knowledge about the condition has improved and the approach to therapy has been enriched with new drugs. Also, the classification of the disease, complex and based on various causes, has varied several times. The data on its spread are rather scarce and incomplete. This paper presents the pathology taking into account the epidemiology, the diagnosis and the present greater understanding of phenomena that contribute to its development. The current management is treated, with focus on the class of the disease on which the studies are most concentrate on, pulmonary arterial hypertension. The drugs acting on three major pathways involved in vascular tone regulation are presented. Finally, other pharmacotherapeutic approaches are exposed, both developing and investigational, as well as potential tecnological approaches designed to implement the site specificity on the treatments.
L'ipertensione polmonare è una patologia caratterizzata da uno spropositato aumento delle resistenze dei vasi polmonari, concomitante a modificazioni fisiopatologiche e a diminuzione del diametro degli stessi. Questo comporta un aumento di lavoro per il cuore destro, il quale col tempo va incontro ad ipertrofia e insufficienza. Nel corso dell'ultimo ventennio le conoscenze sulla condizione sono migliorate e l'approccio alla terapia si è arricchito con nuovi farmaci. Anche la classificazione della patologia, complessa e basata su diverse cause, è variata più volte. I dati sulla sua diffusione rimangono ancora scarsi e incompleti. Questo elaborato presenta la patologia prendendo in considerazione l'epidemiologia della stessa, la diagnosi, e la maggiore comprensione odierna dei fenomeni fisiopatologici che contribuiscono al suo sviluppo. Viene trattata la terapia attuale, con focalizzazione sulla classe della patologia sulla quale si concentrano gli studi, l'ipertensione arteriosa polmonare. Sono quindi presentati i farmaci agenti su tre principali vie coinvolte nella regolazione del tono vasale. Vengono infine esposti altri approcci farmacoterapeutici, in via di sviluppo e investigazionali, oltre a potenziali approcci farmacotecnologici volti ad implementare la sito specificità dei trattamenti.
Ipertensione polmonare: terapia attuale e potenziali approcci futuri
ROSSI, MARINA
2014/2015
Abstract
Pulmonary hypertension is a disease characterized by a disproportionate increase in pulmonary vascular resistance, concomitant with pathophysiological changes and decrease in the diameter of the pulmonary vessels. This results in an increase of work for the right heart, which eventually undergoes hypertrophy and failure. Over the last twenty years the knowledge about the condition has improved and the approach to therapy has been enriched with new drugs. Also, the classification of the disease, complex and based on various causes, has varied several times. The data on its spread are rather scarce and incomplete. This paper presents the pathology taking into account the epidemiology, the diagnosis and the present greater understanding of phenomena that contribute to its development. The current management is treated, with focus on the class of the disease on which the studies are most concentrate on, pulmonary arterial hypertension. The drugs acting on three major pathways involved in vascular tone regulation are presented. Finally, other pharmacotherapeutic approaches are exposed, both developing and investigational, as well as potential tecnological approaches designed to implement the site specificity on the treatments.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/24755