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Calcium-Channel Blockers in Pulmonary Arterial Hypertension

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Pharmacotherapy of Pulmonary Hypertension

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 218))

Abstract

Voltage-activated calcium channels are a family of membrane proteins that provide the major influx pathway for calcium in many different types of cells. Calcium-channel blockers inhibit the calcium influx into vascular cells leading to relaxation of smooth muscle cells and vasodilatation. Vasoconstriction of small pulmonary arteries is recognized as a component of the pathogenesis of pulmonary arterial hypertension and treatment with calcium-channel blockers appears to be rational in this setting. No randomized controlled trial has been performed to demonstrate the beneficial effects of calcium-channel blockers in the treatment of patients with pulmonary arterial hypertension. However, uncontrolled studies have suggested that long-term administration of high-dose calcium antagonists dramatically improves survival in a small subset of patients who respond acutely to those drugs, compared with unresponsive patients. The initial response to an acute vasodilator test with inhaled nitric oxide or intravenous prostacyclin or adenosine accurately identifies patients with pulmonary arterial hypertension who are likely to respond to long-term treatment with calcium-channel blockers.

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Abbreviations

Ca2+ :

Calcium

CCBs:

Calcium-channel blockers

CO:

Cardiac output

DHP:

Dihydropyridine

NO:

Nitric oxide

NYHA:

New York Heart Association

PAH:

Pulmonary arterial hypertension

PAP:

Pulmonary artery pressure

PVR:

Pulmonary vascular resistance

SMC:

Smooth muscle cells

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Author information

Authors and Affiliations

  1. Faculté de Pharmacie, Université Paris-Sud, Chatenay-Malabry, France

    Marie-Camille Chaumais

  2. Service de Pharmacie, Hôpital Antoine Béclère, Clamart, France

    Marie-Camille Chaumais

  3. Centre de Référence de l’Hypertension Pulmonaire Sévère, Service de Pneumologie et Soins Intensifs, CHU de Bicêtre, 78 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France

    Marie-Camille Chaumais, Elise Artaud Macari & Olivier Sitbon

  4. Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France

    Elise Artaud Macari & Olivier Sitbon

  5. INSERM U999, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France

    Elise Artaud Macari & Olivier Sitbon

Authors
  1. Marie-Camille Chaumais
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  2. Elise Artaud Macari
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  3. Olivier Sitbon
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Corresponding author

Correspondence to Olivier Sitbon .

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Editors and Affiliations

  1. Faculte´ de Me´decine, Univ Paris-Sud, Le Kremlin Bicêtre, France

    Marc Humbert

  2. Dep of Anasthesia and Critical Care, Harvard Medical School Massachusetts General Hospital, Boston, Massachusetts, USA

    Oleg V. Evgenov

  3. Cardiovascular Research, Bayer Pharma AG, Wuppertal, Germany

    Johannes-Peter Stasch

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Chaumais, MC., Macari, E.A., Sitbon, O. (2013). Calcium-Channel Blockers in Pulmonary Arterial Hypertension. In: Humbert, M., Evgenov, O., Stasch, JP. (eds) Pharmacotherapy of Pulmonary Hypertension. Handbook of Experimental Pharmacology, vol 218. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38664-0_7

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