RESUMEN

La hipertensión pulmonar (PH) es una patología de la circulación pulmonar. El prototipo de esta enfermedad es la hipertensión arterial pulmonar idiopática (IPAH) que sirve de modelo en investigaciones dirigidas al diagnóstico temprano y tratamiento oportuno. El endotelio vascular pulmonar tiene un papel importante en la enfermedad, los cambios en el mismo originan alteraciones de diferentes moléculas reguladoras del tono vascular, especialmente la disminución en la producción o respuesta al óxido nítrico.
Los esquemas de tratamiento de la PH están dirigidos a disminuir la presión pulmonar y la resistencia vascular pulmonar, así como mejorar la calidad de vida y sobrevida. En pacientes con una respuesta positiva en el test de reactividad vascular pulmonar (TRVP), los antagonistas de canales de calcio son efectivos en un 30% en el largo plazo. En la clínica preocupa el porcentaje tan alto de pacientes que no tienen respuesta en el TRVP, de tal manera que se han evaluado otras drogas con resultados favorables como el óxido nítrico, análogos de prostaciclina (ej. epoprostenol, iloprost), e inhibidores de endotelina 1 (bosentan). En forma reciente se inició la evaluación de los inhibidores de fosfodiesterasa 5 por sus efectos sobre el óxido nítrico a nivel vascular pulmonar.
Sildenafil, vardenafil y tadalafil, efectivos en el tratamiento de la disfunción eréctil, tienen efectos vasodilatadores pulmonares selectivos por medio de incrementar los niveles de óxido nítrico inhibiendo la fosfodiesterasa 5 del endotelio pulmonar. El tratamiento a largo plazo con sildenafil en IPAH, e PH secundaria a enfermedades de la colágena y por enfermedad tromboembólica crónica mostró resultados favorables tanto en calidad de vida como en incremento de sobrevida. Se encuentra en evaluación la efectividad del tratamiento a largo plazo de los diferentes inhibidores de fosfodiesterasa 5 en PH asociada a otras patologías.

PALABRAS CLAVE

Sildenafil, tadalafil, vardenafil, hipertensión pulmonar.

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