Curative Effect Of Bosentan And Tadalafil In Treatment Of Pulmonary Arterial Hypertension

Objective : This study observed and analyzed the effect and safety of the combination therapy with bosentan and tadalafil in patients with pulmonary arterial hypertension(PAH),to provide more clinical reference for the combination therapies of targeted drugs in patients with pulmonary arterial hypertension.Method : A total of 26 PAH patients including 10 males and 16 females aged(43.27±13.93)years old in our hospital were recruited from June 2012 to April 2017.All patients were given combination therapy with bosentan and tadalafil,and WHO functional classifications(WHO FC),6 minutes walk distance(6MWD),Borg dyspnea score,echocardiographic evaluation indexes and physicochemical indexes(NT-proBNP,serum uric acid,total bilirubin and transaminase)were assessed before and after 3-month treatment.At the same time,the adverse drug reactions during treatment were record to evaluate the safety of the combination therapy.Results : After three months of treatment with bosentan and tadalafil,WHO FC,6MWD and Borg dyspnea score were significantly improved compared with the baseline values(P<0.01).Pulmonary artery systolic pressure(PASP)was lower than before(92.3±17.7 mmHg vs 79.2±16.5 mmHg,P<0.01).And the number of patients with pericardial effusion decreased from 11 to 3(P<0.05).Similarly,the physicochemical indexes including total bilirubin,NT-proBNP and serum uric acid were also significantly improved compared with the baseline values [NT-proBNP(ng/L): 1999.5(587.5-3340.0)vs 1236.5(333.0-2176.5),TBil(umol/L):26.0±10.6 vs 20.6±7.4,SUA(umol/L): 410.4±99.9 vs 355.5±125.3,P<0.01].While the right atrium area,right ventricular outflow tract,glutamic-pyruvic transaminase and glutamic-oxalacetic transaminase did not show obvious difference(P>0.05).During the treatment,the common adverse drug reactions were headache and dizziness [1 case(3.8%)],facial flush [2 cases(7.7%)],nausea and vomiting [1 case(3.8%)],increase of transaminase [3 cases(11.5%)] including 2 cases(7.7%)of alanine aminotransferase and 1 case(3.8%)of aspartate aminotransferase.And there were no patients to change their treatment strategies for the inability to tolerate the adverse drug reactions.Conclusion : 1,bosentan plus tadalafil is effective in the treatment of PAH by reducing PASP and improving WHO functional class and exercise capacity.2,this combination therapy is well tolerated and relatively safe.