To Your Good Health: Pulmonary hypertension is elevated lung blood pressure - Corvallis Gazette Times

To Your Good Health: Pulmonary hypertension is elevated lung blood pressure - Corvallis Gazette Times
Pulmonary arterial hypertension device wins FDA breakthrough designation - MedTech Dive
The Therapeutic Benefits of Owning a Pet - Pulmonary Hypertension News

Posted: 09 Sep 2019 07:00 AM PDT

DEAR DR. ROACH: I read an article about a study the Mayo Clinic did using 20 mg tablets of sildenafil for pulmonary arterial hypertension and that it improved walking distance by 75%. Is there an upper age limit for a person using this medication for pulmonary hypertension? — D.L.

ANSWER: Pulmonary hypertension is different from regular or systemic high blood pressure. It's not the kind that is measured with a blood pressure cuff.

In pulmonary hypertension, the elevated pressures are inside the lungs. There are five general classes of pulmonary hypertension, and people must undergo extensive diagnostic testing to determine which subclass they have. The goal is to find a cause that has a specific treatment. For example, subclass 2 is pulmonary hypertension due to heart disease of the left side of the heart, such as heart failure or valvular heart disease. Treating those can make the pulmonary hypertension better.

However, many people do not have a treatable underlying cause that can be identified, so doctors rely on general treatments to improve symptoms. One such is sildenafil, which is called Revatio when used for pulmonary hypertension, but it is the same drug as Viagra. It prolongs the effect of nitric oxide, a chemical in the blood that relaxes blood vessels in the lungs and reduces pressure. Sildenafil, like other drugs in the same class, significantly improved the distance a person could walk in six minutes. The 75% increase you noted is higher than most studies showed, however.

The study included subjects up to 81 years old. I do not think age alone would be a reason not to use these kinds of medications. These medicines should not be used in people taking nitrates (such as nitroglycerine) or those with very low systemic blood pressure.

DEAR DR. ROACH: I've been taking an ACE inhibitor and a calcium channel blocker for the past four months for high blood pressure as advised by my cardiologist. In my blood test a month ago, my vitamin D level was at 16. I'm also taking weekly vitamin B12 as advised by my neurologist. Can I take vitamin D2 (50,000 IU) as a weekly dose for six weeks to overcome vitamin D deficiency, or would it interfere with blood calcium balance? — B.S.

ANSWER: Vitamin D will not interfere with the action of your ACE inhibitor or calcium channel blocker. Vitamin D usually has a very small (if any) effect on blood calcium levels, as these are tightly regulated through multiple means, especially the parathyroid hormone level and the kidneys.

I see many people who are given a six-week course of high-dose vitamin D2, such as the 50,000 units weekly for six weeks you were prescribed. I do not prescribe it that way, since many people wrongly feel that this will "cure" their low vitamin D, and they stop monitoring it after the course of treatment. Many people have inadequate vitamin D levels, and although there is some disagreement about what levels need to be treated, yours is in the range where everyone agrees treatment is necessary. For those who need it, ongoing supplementation of vitamin D is necessary, whether through pills, diet or sun exposure. For most people with a level as low as yours, oral supplementation is by far the most effective and safest treatment. I prefer 1,000-2,000 IU of vitamin D3 daily as a starting point for supplementation in most.

Pulmonary arterial hypertension device wins FDA breakthrough designation - MedTech Dive

Posted: 09 Sep 2019 08:14 AM PDT

Dive Brief:

Tel Aviv-based SoniVie has received FDA's breakthrough device designation for its treatment for pulmonary arterial hypertension (PAH), a form of high blood pressure in the lungs, the company announced Friday.
The device, called TIVUS, is an ultrasound catheter inserted into the pulmonary artery in a right heart procedure designed to ablate nerves associated with disease activity without damaging the vessel walls or adjacent tissues.
SoniVie in May presented data at EuroPCR from a study of 23 PAH patients called the Treatment of Pulmonary Hypertension (TROPHY1) trial that the company said supported the safety of pulmonary denervation using TIVUS and suggested the procedure may improve blood flow and exercise tolerance.

Dive Insight:

PAH, in which obstruction in the small arteries of the lungs increases pressure in the vessels, is a rare condition affecting about 15 to 50 people per million in the United States according to the American Lung Association. The increased blood pressure over time can damage the heart.

Patients typically receive medications to treat PAH. SoniVie's device is the first treatment to use high-frequency non-focused ultrasound energy to ablate nerves associated with PAH. The Israeli startup developed the device based on prior technology designed for renal denervation by Cardiosonic.

In May, the company appointed Charles Carignan as CEO. Carignan is a former CEO of Rex Bionics, BionX Medical Technologies and NinePoint Medical. He also previously held the post of chief medical officer at Novasys Medical and chief medical officer for endosurgery and minimally invasive therapies at Boston Scientific.

The TROPHY1 trial found no serious adverse events related to the device or procedure and showed improvements in pulmonary vascular resistance, mean pulmonary artery pressure, six-minute walk distance, daily activity and European Society of Cardiology (ESC) low-risk indicators compared with baseline assessments. The company has launched a clinical trial of the TIVUS device in Group 2 pulmonary hypertension patients and expects to begin a pivotal trial of the system in 2020.

In addition to gaining assistance from FDA that can accelerate the development and approval process, companies that receive the agency's breakthrough device designation now may also benefit from an alternative reimbursement system. In August, CMS finalized an alternative technology add-on pathway for breakthrough devices under its Inpatient Prospective Payment System for fiscal 2020.

Medtronic is also targeting the PAH market. The device maker last year won FDA approval for an implantable system that delivers the drug Remodulin (treprostinil) developed by United Therapeutics.

The Therapeutic Benefits of Owning a Pet - Pulmonary Hypertension News

Posted: 09 Sep 2019 07:00 AM PDT

My son was 8 years old when he was diagnosed with pulmonary hypertension (PH). Children are supposed to be nurtured, but the attention showered on a child living with a life-threatening disease can begin to feel smothering.

For the five years my son battled PH, I greeted him each morning by asking, "How are you feeling?" I repeated the question throughout the day. Because of his medical condition, I had an extensive treatment regimen that I had to enforce daily. I would nag him about brushing his teeth, doing his homework, going to bed at a decent hour, and other such ordinary concerns, too.

Bedtime routines are often a battle with children, but the one my son endured was far more complicated. One of his PH treatments was intravenous Flolan (epoprostenol GM). A CADD-Legacy pump administered the medication nonstop through a central line in my son's chest. Before bed every night, he had to wait patiently as his dad or I changed his Flolan cartridge, and his central line dressing every other night.

The medication needed to stay cold, so we would ask multiple times a day whether he had changed the ice packs in his Flolan backpack. While other children were being told to tie their shoes to prevent tripping, my son was frequently reminded to tuck in his central line tubing so he wouldn't risk pulling it from his chest.

He was also on a handful of other medications that meant stopping what he was doing to take them. Even less fun were the endless medical appointments and hospital stays, when he was asked endless questions and received extensive care.

Well-nurtured by doctors, family, and friends, my son maintained a good quality of life until he declined at age 13. On Aug. 30, 2013, he was officially listed for a heart and double-lung transplant.

As he tried to process this new reality, he thoughtfully turned to his father and me and asked, "Once I receive my transplant, can I get a dog?" We already had a dog, but he wanted to select a puppy of his own, name it, and take on most of the responsibility for its care. Sensing that he wasn't taking advantage of an emotional situation but making a request of deeper meaning, we promised him a dog.

He received his transplant on Aug. 7, 2014. Six months later, with the most challenging days of recovery behind him, I decided it was time to keep that promise. My son wanted a rescue dog, so we headed to the Humane Society shelter.

It didn't take long for a 6-month-old puppy with a pink-striped nose to get his attention. That evening, we adopted the little Jack Russell terrier, which my son later named Mellow. As we drove home with her, she sat on my son's lap as if they were long-lost friends.

Mellow, the Jack Russell terrier (Photo by Colleen Steele)

Mellow loves her family, but is most loyal to my son. She seems to know instinctively when he isn't feeling well, and loyally remains by his side, providing quiet comfort. She is also very protective, and will relentlessly bark at anything or anyone she thinks is causing him stress or harm. If left to her own devices, I think she would bravely take on my son's blood pressure machine and break it into pieces. This and her fun-loving, playful side have made her the perfect furry best friend for my son.

Other than the joy of companionship, I think the deeper reason my son wanted a dog was to have someone of his own to nurture. He pictured an opportunity to someday be the caregiver to a sweet little rescue dog, and when his dream came true, she did not disappoint. Being depended on has brought him as much joy as the companionship. It invites the question, "Who rescued whom?"

She is everything he wanted and needed in a dog. Perhaps divine intervention helped them find each other.

If you or a loved one have ever had the pleasure of being visited by a therapy dog while in the hospital, you have an idea of the emotional healing power the love of an animal can provide. Whether it be a dog, cat, or bird, consider adopting an animal. Just be sure to discuss it with your doctor first.

The French poet and novelist Anatole France once said in a speech, "Until one has loved an animal, a part of one's soul remains unawakened." My son would tell you that truer words have never been spoken.

***

Note: Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Hypertension News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to pulmonary hypertension.

Search This Blog

Pulmonary Hypertension