Isosorbide-5-mononitrate in the treatment of pulmonary hypertension associated with portal hypertension

Pulmonary hypertension is uncommonly associated with portal hypertension. T he current approach for the management of pulmonary hypertension involves t he use of vasodilators in patients who show vascular responsiveness during an acute challenge. Since the association of portal hypertension with pulmo nary hypertension is very seldomly presented, its optimal; therapy has not been defined. Moreover, calcium-channel blockers, which are usually used in pulmonary hypertension treatment, may exert a deleterious effect on portal hypertension. Therefore, the search for drugs that may be active under bot h conditions has important clinical implications. This report presents the case of a patient with portal hypertension-associa ted pulmonary artery hypertension that was effectively treated with isosorb ide-5-mononitrate (Is-5-Mn). The patient had severe portal hypertension (he patic venous pressure gradient=14.5 mmHg) and pulmonary hypertension (mean pulmonary artery pressure (PAP)=50 mmHg). Acute administration of prostacyc lin and nitric oxide elicited a significant reduction in both PAP and pulmo nary vascular resistance (PVR), an effect that was also achieved with Is-5- Mn, The patient was treated with 40 mg Is-5-Mn twice daily and a haemodynam ic study performed 6 months later showed that the reduction in both PAP and PVR persisted.