Drug-induced pulmonary hypertension

PPH), heritable pulmonary hypertension, drug- and toxin-induced pulmonary hypertension, associated with known disease (APAH), persistent pulmonary hypertension of the newborn, and pulmonary veno-occlusive disease (PVOD) and/or pulmonary capillary hemangiomatosis (PCH). 

All drugs inducing a constantly increased serotonin level may induce pulmonary hypertension on the basis of a hypertrophic smooth muscle layer of small pulmonary arteries. 

Follath F, Burkart F, Schweizer W. Drug-induced pulmonary hypertension BMJ 1971 l(5743) 265-6. 

Schnabel KF, Schultz V, Busch S, Just H. Drug-induced primary vascular pulmonary hypertension. Med Welt (Stuttgart) 1976 27 1300-1303. 

Heritable forms of PAH (previously familiar or FPAH) remains a rare occurrence, includes approximately 300 families, and has been linked to BMPR-2, endoglin and TGF- 3 receptor mutations (7). The discovery of the BMPR-2 abnormality led to the focus on the TGF-p and SMAD pathways (8). Drug and toxin induced pulmonary hypertension is now a separate subcategory. 

Minoxidil has particularly adverse consequences in hypertensive patients who have left ventricular hypertrophy and diastolic dysfunction. Such poorly compliant ventricles respond subopti-mally to increased volume loads, with a resulting increase in left ventricular filling pressure. This likely contributes to the increased pulmonary artery pressure seen with minoxidil therapy in hypertensive patients and is compounded by the drug-induced retention of salt and water. Cardiac failure can result from minoxidil therapy in such patients the potential for this complication can be reduced but not prevented by effective diuretic therapy. Pericardial effusion is an uncommon but serious complication of minoxidil. Although more commonly described in patients with cardiac failure and renal failure, pericardial effusion can occur in patients with normal cardiovascular and renal function. Mild and asymptomatic pericardial effusion is not an indication for discontinuing minoxidil, but the situation should be monitored closely to avoid progression to tamponade. Effusions usually clear when the drug is discontinued but can recur if treatment with minoxidil is resumed. 

Montani D, Seferian A, Savale L, Simonneau G, Humbert M. Drug-induced pulmonary arterial hypertension a recent outbreak. European... 

Other complications in addicts Brown and Quoc Khoa (6 ) malaria in narcotic injectors Husby et al. (26 ) raised smooth muscle antibody in addicts Schofferman et al. (51 ) microangiopathic haemolytic anaemia. This followed a foreign body-induced pulmonary hypertension as a complication of intravenous drug abuse. 

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