Hypertension: Rubin LJ

McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J, Anonymous00029, Anonymous00030, Anonymous00031, Anonymous00032, Anonymous00033. · No affiliation provided · J Am Coll Cardiol. · Pubmed #19389575 No free full text.

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Badesch DB, Abman SH, Simonneau G, Rubin LJ, McLaughlin VV. · University of Colorado Health Sciences Center, Box C-272, 4200 E. Ninth Ave, Denver, CO 80262, USA. · Chest. · Pubmed #17565025 links to  free full text

Abstract: A consensus panel convened by the American College of Chest Physicians developed guidelines for the treatment of pulmonary arterial hypertension (PAH) that were published in 2004. Subsequently, several important clinical trials have been published, and new treatments have received regulatory approval. In addition, add-on and combination therapy are being explored, which promise to open new therapeutic avenues. This article, taking into consideration studies published prior to September 1, 2006, provides an update to the previously published guidelines. The original guidelines have been summarized, a discussion of new studies has been added, and the treatment algorithm has been revised to take into account recent developments in therapy. This update provides evidence-based treatment recommendations for physicians involved in the care of patients with PAH. Due to the complexity of the diagnostic evaluation required and the treatment options available, referral of patients with PAH to a specialized center continues to be strongly recommended.

Galiè N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, Olschewski H, Peacock A, Pietra G, Rubin LJ, Simonneau G, Anonymous00341. · Institute of Cardiology, University of Bologna, Italy. · Rev Esp Cardiol. · Pubmed #15899198 links to  free full text

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Galiè N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, Olschewski H, Peacock A, Pietra G, Rubin LJ, Simonneau G, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie M, Dean V, Deckers J, Burgos EF, Lekakis J, Lindahl B, Mazzotta G, McGregor K, Morais J, Oto A, Smiseth OA, Barbera JA, Gibbs S, Hoeper M, Humbert M, Naeije R, Pepke-Zaba J, Anonymous00032. · No affiliation provided · Eur Heart J. · Pubmed #15589643 links to  free full text

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Rubin LJ, Anonymous00034. · Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, USA. · Chest. · Pubmed #15249491 links to  free full text

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Rubin LJ, Anonymous00033. · Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, USA. · Chest. · Pubmed #15249490 links to  free full text

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Opitz CF, Rubin LJ. · No affiliation provided · Eur Respir J. · Pubmed #19483043 No free full text.

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Oudiz RJ, Rubin LJ. · No affiliation provided · Circulation. · Pubmed #19015412 No free full text.

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Rubin LJ. · No affiliation provided · Am J Respir Crit Care Med. · Pubmed #18522952 links to  free full text

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Rubin LJ. · No affiliation provided · Circulation. · Pubmed #17000920 links to  free full text

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Kim NH, Rubin LJ. · No affiliation provided · Crit Care Med. · Pubmed #16148499 No free full text.

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Yuan JX, Rubin LJ. · No affiliation provided · Circulation. · Pubmed #15699271 links to  free full text

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Rubin LJ, Naeije R. · No affiliation provided · Ann Intern Med. · Pubmed #15289224 links to  free full text

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Kerr KM, Rubin LJ. · No affiliation provided · Chest. · Pubmed #12576339 links to  free full text

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Rubin LJ. · No affiliation provided · Am J Respir Crit Care Med. · Pubmed #12421739 links to  free full text

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Rubin LJ. · No affiliation provided · Crit Care Med. · Pubmed #11378627 No free full text.

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McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J, Harrington RA, Anderson JL, Bates ER, Bridges CR, Eisenberg MJ, Ferrari VA, Grines CL, Hlatky MA, Jacobs AK, Kaul S, Lichtenberg RC, Lindner JR, Moliterno DJ, Mukherjee D, Pohost GM, Rosenson RS, Schofield RS, Shubrooks SJ, Stein JH, Tracy CM, Weitz HH, Wesley DJ, Anonymous00037. · No affiliation provided · Circulation. · Pubmed #19332472 No free full text.

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Chin KM, Rubin LJ. · Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA. · J Am Coll Cardiol. · Pubmed #18420094 No free full text.

Abstract: Significant advances in the treatment of pulmonary arterial hypertension (PAH) have occurred over the last 10 years, starting with the approval of epoprostenol in 1998. Subsequently, multiple additional medications have received approval, including a subcutaneous prostacyclin, an inhaled prostacyclin, and oral medications in 2 separate classes. Over this same period, the classification of pulmonary hypertension has been revised with changes including the substitution of the term idiopathic for primary PAH and an expanded list of conditions felt to be associated with the development of PAH. Long-term follow-up studies have provided better information on prognosis and expected outcomes with treatment, with particularly valuable data on reassessment of prognosis after treatment with epoprostenol. Combination therapy is more frequently being used, and limited data on novel therapies such as stem cell transplantation have been published. The purpose of this review is to describe the current state of evidence for the diagnosis, prognosis, and treatment of the patient with PAH.

Rubin LJ. · University of California, San Diego School of Medicine, 9300 Campus Point Drive, La Jolla, CA 92032, USA. · Rheum Dis Clin North Am. · Pubmed #18329540 No free full text.

Abstract: Although progress has been made in treatment of pulmonary arterial hypertension, serious challenges remain. This article provides an overview of the challenges faced in treatment of PAH caused by scleroderma. It also provides a glimpse into the future, based on recent developments in the field that hold promise for enhancing the treatment of this disease.

Rubin LJ, Hoeper MM, Klepetko W, Galiè N, Lang IM, Simonneau G. · University of California, San Diego, CA, USA. · Proc Am Thorac Soc. · Pubmed #16963541 links to  free full text

Abstract: Although pulmonary endarterectomy (PEA) has been proven a very effective treatment for chronic thromboembolic pulmonary hypertension, it cannot be performed in a substantial proportion of patients. Here, we outline a proposed treatment algorithm, outlining therapeutic alternatives: (1) PEA should be considered as the first treatment option, where possible; (2) medical intervention is a possible option in inoperable patients and those with significant arteriopathy, although only chronic anticoagulation has been widely used to date (advanced medical treatment options could include prostanoids, endothelin receptor antagonists, or phosphodiesterase-5 inhibitors, but randomized clinical trials are required); (3) pulmonary hypertension is likely to persist after PEA in patients with significant small-vessel arteriopathy, resulting in poor clinical outcome and increased perioperative mortality (medical therapy could also be applied here); (4) anticoagulation therapy and, possibly, advanced medical treatment with careful monitoring may provide benefits in patients with mild or asymptomatic disease; (5) if medical therapy begins to fail, PEA should be offered without delay to avoid progression to severe, secondary arteriopathy; (6) in the absence of severe comorbidity, lung transplantation may be undertaken where PEA has failed, in nonresponders to medical therapy, and in patients with progressive arteriopathy; (7) in patients not eligible for PEA due to collateral and/or surgically inaccessible lesions, balloon angioplasty may be a possible alternative at some centers, but is experimental and requires further assessment. Continued research and clinical trials investigating possible applications of new medical treatments are required.

Hoeper MM, Mayer E, Simonneau G, Rubin LJ. · Department of Respiratory Medicine, Hannover Medical School, 30623 Hannover, Germany. · Circulation. · Pubmed #16636189 links to  free full text

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Hoeper MM, Rubin LJ. · Department of Respiratory Medicine, Hannover Medical School, 30623 Hannover, Germany. · Am J Respir Crit Care Med. · Pubmed #16493163 links to  free full text

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Rubin LJ. · University of California, San Diego, School of Medicine, 9300 Campus Point Drive, La Jolla, CA 92037, USA. · Proc Am Thorac Soc. · Pubmed #16493158 links to  free full text

Abstract: Pulmonary arterial hypertension (PAH) is a term used to classify a variety of conditions that have in common an injury to the pulmonary vasculature that produces elevations in pulmonary arterial pressure. There have been considerable advances in our understanding of the pathogenesis and treatment of PAH over the past decade. The article reviews the classification of diseases associated with PAH, the current understanding of its pathogenesis, and the contemporary approach to therapy.

Hsu HH, Rubin LJ. · CoTherix, Inc., 5000 Shoreline Court, San Francisco, CA 94080, USA. · Expert Opin Pharmacother. · Pubmed #16144511 No free full text.

Abstract: Pulmonary arterial hypertension (PAH) is a condition that is characterised by increased pulmonary arterial pressure and vascular resistance that can lead to right ventricular failure and death. A variety of disturbances in pulmonary vascular endothelial and smooth muscle function are present in PAH, including reduced production of vasodilator and antiproliferative substances, such as nitric oxide and prostacyclin, and an overproduction of mitogens, such as endothelin. As a result of these observations, therapies have been developed for PAH that specifically target these pathogenic processes, including prostacyclin analogues and endothelin receptor antagonists. This article reviews iloprost inhalation solution, the most recently approved form of prostacyclin therapy that is delivered directly to the lungs by inhalation.

Lee SH, Rubin LJ. · Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA 92037-7381, USA. · J Intern Med. · Pubmed #16115293 No free full text.

Abstract: Pulmonary arterial hypertension (PAH) is a disease characterized by an elevation in pulmonary artery pressure that can lead to right ventricular failure and death. Although there is no cure for PAH, newer medical therapies have been shown to improve a variety of clinically relevant end-points including survival, exercise tolerance, functional class, haemodynamics, echocardiographic parameters and quality of life measures. Since the introduction of continuous intravenous prostacyclin, the treatment armamentarium of approved drugs for PAH has expanded to include prostacyclin analogues with differing routes of administration, a dual endothelin receptor antagonist, and a phosphodiesterase-5 inhibitor. Selective endothelin-A receptor antagonists have shown promise in clinical trials and are likely to be added to the list of options. As the number of medications available for PAH continues to increase, treatment decisions regarding first-line therapy, combination treatments, and add-on strategies are becoming more complex. This article reviews the current treatments strategies for PAH and provides guidelines for its management.