ABSTRACT
The definition of “conventional therapy” for pulmonary arterial hypertension (PAH) is sometimes unclear for clinicians. What is “conventional” to one may be considered differently by another, depending on a disease’s awareness, availability of therapies, and a clinician’s habits. Indeed, it would be better to consider conventional therapy as the combination of general measures (first of all, not to harm) and supportive therapies (anticoagulants, diuretics, supplemental oxygen, etc.). Historically, treatment with calcium channel blockers (CCBs) was also considered as conventional therapy as it was the only vasodilator that has demonstrated clinical efficacy (in a small subset of patients with idiopathic PAH) before availability of treatments targeting endothelial dysfunction [prostanoids, endothelin receptor antagonists (ERAs), phosphodiesterase inhibitors, etc.]. No randomized controlled study has been performed to evaluate conventional therapy in patients with PAH, and the rationale for using it is based on the results of uncontrolled observational studies only (1). In addition, these studies were performed mostly in patients with idiopathic PAH, and extension of their conclusions to PAH associated with other diseases and conditions has to be done with caution. In the national North American Registry of 194 patients with PAH, most received conventional therapy including oral anticoagulants, diuretics, supplemental oxygen, cardiac glycosides, and CCBs (2). At that time, the median survival was 2.8 years (2). Medical advances over the last twenty years have resulted in significant improvement in the prognosis of this condition. Today, conventional therapy has to be considered in combination with disease-specific targeted PAH treatments in patients with PAH.
