PT  - JOURNAL ARTICLE
AU  - O. Sitbon
AU  - N. Galiè
TI  - Treat-to-target strategies in pulmonary arterial hypertension: the importance of using multiple goals
AID  - 10.1183/09059180.00008210
DP  - 2010 Dec 01
TA  - European Respiratory Review
PG  - 272--278
VI  - 19
IP  - 118
4099  - http://err.ersjournals.com/content/19/118/272.short
4100  - http://err.ersjournals.com/content/19/118/272.full
SO  - EUROPEAN RESPIRATORY REVIEW2010 Dec 01; 19
AB  - Major advances have occurred in the treatment of pulmonary arterial hypertension (PAH) over the past decade. The advent of PAH-specific pharmacological treatments has offered hope to patients with a debilitating, progressive disease and a poor prognosis. Combined drug treatment offers improved benefits over monotherapy, and current treatment guidelines for PAH recommend a sequential add-on approach to combination therapy for patients in New York Heart Association (NYHA)/World Health Organization functional class (WHO FC) II–IV. Goal-oriented therapy determines the timing of treatment escalation by inadequate response to known prognostic indicators. Close monitoring of patients aids the early identification of inadequate response, so that treatment can be escalated promptly and before the patient's condition deteriorates further. Existing treatment goals are based on baseline values of prognostic indicators, but it is vital to identify risk factors that are both relevant during treatment and that can be assessed during follow-up appointments. Data from different PAH aetiologies indicate that NYHA/WHO FC is the most appropriate prognostic marker, with 6-min walk distance and several haemodynamic parameters representing alternatives. Future refinement of goal-oriented therapy could include the use of multiple prognostic markers, while additional, large clinical trials will answer questions concerning choice and combination of treatment goals.