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Pulmonary blood pressure

March 18th, 2015

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Pulmonary blood pressure

When talking about blood pressure, people are usually referring to peripheral arterial blood pressure, which is measured by strapping a band around the upper arm, or by an automatic machine that can detect it from the wrist or the tip of a finger. Blood pressure of the vein can also be measured, but not by the same methods. It can be checked on a vein in the neck.

Coronary artery blood pressure is measured by inserting a small tube inside, just like measuring pressure in the lungs. Pulmonary blood pressure, however, can be indirectly checked by using an ultrasound technique (echocardiogram).

High blood pressure, the kind that increases the risk of narrowed arteries, paralysis or kidney failure, is measured in the peripheral arteries. In fact, blood pressure, no matter from which source, is interconnected. If blood pressure at one site is high, others are likely to be the same. Look at it as the water level during a flood. A little rise might cause a small swamp somewhere else, but if the level keeps rising, other places will be flooded as well.

High blood pressure in peripheral arteries is, as most people know, an important thing to control. How to control it is also something everyone – patients and doctors alike – know like the back of their hand, but how well are we going to stick to the guidelines? That’s a personal decision.

High pulmonary blood pressure is more commonly found. Patients with this disease usually visit a doctor because they are experiencing tiredness, shortness of breath and swelling in their legs and abdomen, but it typically gets better after rest. In some patients, leg swelling occurs because of right chamber failure. In very severe cases, the lips, fingertips and nails become darker. For these patients, if they so much as strain when they have a bowel movement, for example, they can feel dizzy or even pass out.

High pulmonary blood pressure patients can experience right chamber heart failure as well. The chamber receives blood from every organ in the body and sends it to the lungs to increase oxygen and remove carbon dioxide. If the blood pressure in the lungs increases, the right chamber has to work harder to push blood into the lungs. Normally, the right chamber is not as strong as the left, so when it has to work hard, it will enlarge and this results in failure and swelling of the limbs and tummy.

The cause of high pulmonary blood pressure can be many things, such as smoking, diet pills, over-inflation of the lungs’ air sacs (emphysema), chronic bronchitis, and more commonly found lately, blockage of the pulmonary artery, thalassaemia and chronic pulmonary inflammation in patients with HIV.

In the past, treating high pulmonary blood pressure was not very successful as there was no medication that directly decreased pressure in the lungs, unlike hypertension medication for peripheral arteries. There were only medications for swelling, urination, bronchial tube expansion or the prevention of further blockage in the lungs. These medications could make the patients feel better, but did not tackle the source of the problem, which is the pressure in the lungs. The right chamber would still have to work harder and eventually the patients would end up with right chamber heart failure, which would take their lives.

Pulmonary blood pressure, once high, will continue to rise. In the past, it was slowed down by giving a patient oxygen around the clock, or when he or she slept. However, this method doesn’t extend a life for that long.

Now, luckily, we have medication that can reduce blood pressure in the lungs. This medicine was developed almost by accident. It was actually invented to treat narrowed arteries for patients with myocardial infarction. However, it was still being tested at the time, until it was found that there was a very desirable side effect: the enlargement of penile capillaries. This, in turn, caused the erection of the penis. It was decided that the medicine would work better to stimulate penile erections than to widen the coronary artery.

Therefore, it was advertised as a cure for men with erectile dysfunction. Interestingly, it was also found that erectile dysfunction is directly linked to narrowed artery disease.

This erectile medication, after a while, was found to help decrease pulmonary blood pressure. It was tested again as a cure for high blood pressure in the lungs. At present, this medicine has been approved for treating high pulmonary blood pressure, but it is still quite costly and must be continued for life. High blood pressure in the lungs is commonly found in women, mostly aged 50-60 and up. So, consider yourself lucky if you are a man with erectile dysfunction as well as pulmonary hypertension, since you will need only one medication, which can kill two birds with only one shot.

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.

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