Hypertension milrinone

In a randomized, open study of milrinone and dobuta-mine in 120 patients with low cardiac output after cardiac surgery, the two drugs were roughly comparable in efficacy (8). Adverse events were more frequent with dobutamine (77%) than with milrinone (58%). With milrinone cardiovascular adverse events were the most common, including hypertension (13%), hypotension (20%), bradycardia (13%), new atrial fibrillation (5%), and tachycardia (8%). Other adverse events included hemorrhage and oliguria. Adverse events required withdrawal from the study in 20 patients who took milrinone. 

Inhaled milrinone has been used to treat patients with pulmonary hypertension after cardiac surgery (21). Milrinone produced a significant dose-related reduction in pulmonary vascular resistance in nine patients. There were no systemic adverse effects. 

Treatment strategies for progressive pulmonary venous hypertension should focus on treatment of the underlying disease. For patients with advanced decompensated systolic heart failure and secondary pulmonary hypertension, it is essential to reduce the pulmonary vascular resistance prior to heart transplantation to prevent acute RV failure of the donor heart. The use of continuous milrinone, occasionally nesirit-ide, and earlier intervention with mechanical circulatory device support (19) as a bridge to cardiac transplantation is considered a standard approach for this group of patients. Earlier intervention with valve repair or replacement for patients with mitral valve disease and aortic valve disease with associated pulmonary hypertension is recommended. 

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