Can Hypoxia Induced Pulmonary Hypertension be Treated with a Combination of MgSO4, Alpha Blocker as Well as Angiotensin Converting Enzyme Inhibitor?

Document Type : Review Article/ Systematic Review Article/ Meta Analysis

Author

MD, PhD, MBA, King Faisal Specialist Hospital & RC, Jeddah, Saudi Arabia

Abstract

Pulmonary hypertension (PHT) has classically been treated with expensive vasodilators. Through the treatment of hypoxia-induced PHT as well as postoperative hypoxia by proxy PHT, possible alternatives in treatment have been discovered. Results of the aforementioned treatments and patient interventions have been discussed in this paper. Medications discussed individually are MgSO4, ACE inhibitors, and alpha blockers as well as their implementation in therapeutic regimens. The conclusions drawn from those largely successful interventions lead to a proposal for the development of an alternative medication for the hypoxia-induced pulmonary hypertension that theoretically would prove to be as inexpensive as it would be effective. Bringing together the results of the aforementioned research, this medication would consist of MgSO4, ACE Inhibitors, and alpha blockers. It is inferred that a triple therapy of the three drugs would allow for synergistic effects and reduce the side effects to a minimum. The goal would be to develop a medication that can be used for all the communities where it is needed, regardless of their medical development or financial flexibility.

Keywords


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1.Xu Y, LiuY, Liu J, Qian G. Meta-Analysis of clinical efficacy of sildenafil, a phosphodiesterase type-5 inhibitor on high altitude hypoxia and its complications. High Alt MedBiol. 2014;15(1):46-51.
https://doi.org/10.1089/ham.2013.1110
PMid:24673534
 
2. Oelz O, Maggiorini M, Ritter M, Noti C, Waber U, Vock P, et al. Prevention and treatment of high altitude pulmonary edema by a calcium channel blocker. Int J Sports Med. 1992;13(Suppl1):S65-8.
https://doi.org/10.1055/s-2007-1024598
PMid:1483797
 
3. Abu-Osba YK, Rhydderch D, Balsundasam S, Galal O, Rajjal A, Halees Z, et al. Reduction of hypoxia-induced pulmonary hypertension (HIPH) by MgSO4 in sheep. Pediatr Res. 1990; 27:351A.
 
4. Cropp GJ. Reduction of hypoxic pulmonary vasoconstriction by magnesium chloride. J Appl Physiol. 1968;24(6):755-60
https://doi.org/10.1152/jappl.1968.24.6.755
PMid:5653158
 
5. Abu-Osba YK, Galal O, Manasra K, Rajjal A. Treatment of severe pulmonary hypertension of the newborn with magnesium sulphate. Arch Dis Child. 1992;67(1 Spec NO):31-5.
https://doi.org/10.1136/adc.67.1_Spec_No.31
PMid:1536582 PMCid:PMC1590342
 
6. Tolsa JF, Cotting J, Sekarski N, Payot M, Micheli JL, Calame A. Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn. Arch Dis Child Fetal Neonatal Ed. 1995;72(3):F184-7.
https://doi.org/10.1136/fn.72.3.F184
PMid:7796235 PMCid:PMC2528455
 
7. Patole SK, Finer NN. Experimental and clinical effects of magnesium infusion in the treatment of neonatal pulmonary hypertension. Magnes Res. 1995;8(4):373-88. [PubMed: 8861137].
 
8. Galal O, Dzimiri N, Bakr S, Moorji A, Almotrefi AA. Sympathetic activity in children undergoing balloon valvuloplasty of pulmonary stenosis. Pediatr Res. 1996;39(5):774-8.
https://doi.org/10.1203/00006450-199605000-00005
PMid:8726227
 
9. Dzimiri N, Galal O, Moorji A, Bakr S, Abbag F, Fadley F, et al. Regulation of sympathetic activity in children with various congenital heart diseases. Pediatr Res. 1995;38(1):55-60.
https://doi.org/10.1203/00006450-199507000-00010
PMid:7478797
 
10. Dzimiri N, Galal MO, Moorji A, Almotrefi AA. Influence of hypoxia on adrenoceptor activity in children with tetralogy of Fallot. Eur Heart J. 1995;16(Suppl):403.
 
11. Galal O, Kalloghlian A, Pittapilly BM, Dzimiri N. Phentolamine improves clinical outcome after balloon valvuloplasty in patients with critical pulmonary stenosis. Cardiol Young. 1999;9(2):127-8. 12. Galal O, Arfi AM, Ata JA, Hussain A, Kouatli A. Alpha(2)-blocker helps to avoid systemic to pulmonary shunt in a prostaglandin dependent infant with critical pulmonary valve stenosis. J Coll Phys Surg Pak.2006;16(12):780-2.
https://doi.org/10.1017/S1047951100008325
PMid:10323508
 
13. Galal MO, Alzahrani AM, Elhoury ME. Angiotensin converting enzyme inhibitor as an additive treatment after successful balloon dilation of a critical pulmonary valve stenosis. J Saudi Heart Assoc. 2012;24(1):47-50
https://doi.org/10.1016/j.jsha.2011.10.002
PMid:23960668 PMCid:PMC3727407
 
14. Galal MO, KhanMA. Alpha blocker and angiotensin-converting enzyme inhibitor in the management of severe pulmonary valve stenosis: from bench to bedside. Cardiol Young. 2015;25(7):1306-10
https://doi.org/10.1017/S1047951114002418
PMid:25543957
 
15. Kanno S, Wu YL, Lee PC, Billiar TR, Ho C. Angiotensinconverting enzyme inhibitor preserves p21 and endothelial nitric oxide synthase expression in monocrotaline-induced pulmonary arterial hypertension in rats. Circulation. 2001;104(8):945-50.
https://doi.org/10.1161/hc3401.093155
PMid:11514384