[MD, Doctor of Medical Science, Head of the Department of Pulmonary Hypertension and Heart Diseases, Myasnikov Clinical Cardiology Institute].

Abstract

The review addresses principal approaches to intensifying therapy in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The position of Russian experts on the strategy of switching within one class of PAH-specific therapy is presented. Particular attention is paid to the strategy of therapy optimization in the form of replacing phosphodiesterase type 5 inhibitors with a stimulator of soluble guanylate cyclase (riociguat) in patients with PAH and inoperable/residual CTEPH who cannot not achieve treatment goals on phosphodiesterase type 5 inhibitors. The authors analyzed and identified the criteria justifying the choice of a specific therapy strategy in favor of switching from a phosphodiesterase type 5 inhibitor to riociguat.