Pulmonary hypertension with co-morbidities, how to resolve it?

2022 was a decisive year for healthcare providers responsible for patients high blood pressure in the arteries of the lungsBecause this was the moment in which clinical guidelines Available from 2015 to present – ​​this was updated to revolutionize the paradigm regarding the approach to pathology. The twenty-third winter meeting of the Spanish Society of Pulmonology and Thoracic Surgery (SAPER) has been the perfect setting to address point by point the changes brought about by the new document. Researchers, professionals and patients In the table conducted by experts, directly related to this pathology Gregorio Miguel Pérez Penate And isabel blanco witch,

For Ernest Sala, Head of Pulmonology Service Son Espaces Hospital (Palma de Mallorca), the update has been a trigger for “Lights and Shadows” Therapeutic algorithm for this pathology. First of all, he wanted to clarify his position regarding these documents, which in his opinion have a guiding role: “The guides are there to help us, but we do not have to follow them ‘to the letter’, and even less . When 80 percent are opinions, “Even if they are experts.”

Subsequently, he highlighted that with the change of the document Your definition of disease As well as the scale of its detection, something that in his opinion has since “made sense”. There is a direct impact on mortality rate. The ultimate purpose of not only this specific guide, but the vast majority – or even all – of these documents is Prevention in case of “early diagnosis” This will allow treatment to start as soon as possible.” “we are looking foranticipate symptoms and proceed even into those that have not been examined”, something, as he himself proceeds, “will not be viable in the short term”, especially with patients who are not included in clinical trials. However, one expert estimates that, looking to the future, “the necessary groundwork has already been laid”.

Among the benefits provided by the new guide, Sala highlights specific points such as more importance of physical trainingbetter monitoring of medicinal treatment Recommendations for or specific patient grouponce fixed congenital heart disease, But the issue that has made the biggest impact is Approach to patients with comorbidities and their prior evaluation to choose the relevant approach, something that did not appear in previous guides. In fact, this point, in Sala’s opinion, represents “the The most compromising aspect of the therapeutic algorithm”, since “further evidence is still needed” regarding the role of these conditions before as well as treatment.

The future in the treatment of pulmonary hypertension

It has emerged on similar lines pilar escribano, specialist in cardiology. In his opinion, the approach high blood pressure in the arteries of the lungs It’s a “very sweet moment,” as new “medical options are coming on the horizon” and health workers “can even touch some with their hands.”

Despite the achievements made with formulation of new drugsEscribano demands that some improvements be included in the study to develop some of them. “need testing with older population, about 300 randomized patients,” he explains, citing this factor as the main reason why, in his opinion, patients with co-morbidities remain “a big suspect in the approach to pulmonary hypertension” because they do not include Are. This survey. In fact, for this cardiologist, “finding patients without an A.” screening Of earlier Given the current outlook of his research this is just the result of coincidences, but he believes “this is the path to follow in the long term”. joint treatmentmany of these Drugs,

amaya martinez, The pulmonologist and coordinator of SAPER’s Pulmonary Circulation Area also testified to Sala and Escribano, pointing out that trials conducted in this area are based on “very pure patients” based on the definition of pulmonary hypertension prior to the current guideline. Blood pressure… That is why “concomitant diseases are left out” when it comes to finding out what new drugs can be used and combined in these patients.

In his opinion, we are facing a “fourth way” of treating this pathology, but like Escribano, he does not rule out that the future will bring a “fifth option” as a result. simultaneous administration of several of these formulas, “Over time there will be studies that tell us how to combine them,” he says.

Role of nursing in the management of pulmonary hypertension

From Nurse Perspective, Ana Maria Ramirez As a professional expert in this pathology explained in detail, “guides are not sensitive to it.” pathological changes and should be used specific questionnaireWhich takes into account the peculiarities of each person. In the case of the most recent document, it has pointed to positive aspects compared to its previous deliveries such as “vaccinations, administration of supplemental oxygen while traveling or recommendations related to pregnancy”, among others.

Ramirez also highlighted the importance of “identifying patients in need.” Psychological and psychiatric referralAnd recommend that they request support through patient groups and associations. On the other hand, they have pointed out the need to educate patients and ensure their care treatment adherence As well as “planning for palliative care relatively far in advance when the time comes,” he says.

Gregorio Miguel Pérez Penate and Isabel Blanco Vich, pulmonologists and moderators of the table.