Acute Hemodynamic Effects of Nitroglycerin in Pulmonary Hypertension

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Abstract
Therapy of pulmonary hypertension is limited by the low potency and adverse effects of current pulmonary vasodilators. The hemodynamic effects of nitroglycerin in human pulmonary hypertension are not known. Nitroglycerin was administered to 9 patients with chronic pulmonary hypertension. Nitroglycerin increased cardiac index 40% (P < 0.01), increased stroke volume 40% (P < 0.01), decreased pulmonary vascular resistance 40% (P < 0.01) and decreased mean pulmonary artery pressure 15% (P < 0.01). Pulmonary vascular resistance decreased more than 25% in 8 of the 9 patients. In 4 patients, the effects of i.v. nitroglycerin were reproduced by topical nitroglycerin preparations; cardiac index increased 50%, stroke volume increased 48%, pulmonary vascular resistance decreased 43% and mean pulmonary artery pressure decreased 19%. Five of 6 patients treated with long-acting nitrates had substantial improvement of their symptoms. Therapy with nitroglycerin evidently can be effective in patients with severe pulmonary hypertension.

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