Cardiology & Vascular Research

Author'(s): Shima Haghani M.D^*

Department of Clinical Research, Tehran University of Medical Sciences, Tehran Heart Center, Tehran, Iran.

^*Correspondence:

Shima Haghani M.D, Cardiovascular Disease MSc, Senior Cardiovascular Disease Researcher, Department of Clinical Research, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran-Iran, Tel: +98 2188029256, Fax +98 2188029256, E-mail: sh_haghani1@yahoo.com.

Received: 06 Mar 2022; Accepted: 04 Apr 2022; Published: 10 Apr 2022

Citation: Haghani S. Medical Management of Pulmonary Hypertension: Calcium Channel Blockers Vs Sildenafil A Systematic Review. Cardiol Vasc Res. 2022; 6(3): 1-9.

Introduction
Rationale

Pulmonary hypertension is a problematic heart related disease by which around half of the population of UK have suffered and the potency is almost same in case of infants and aged people. In this section, problems regarding pulmonary hypertension and its probable therapies are highlighted.

Pulmonary hypertension is one of the common heart diseases of United Kingdom and more than 7 thousand people are affected per year by its vulnerability. As per the view of Kim et al. [1], this heart contingency has delivered negative effect on patients and more than 40% infants are affected badly due to this. On the other hand, it has also been shown that number of affected people in UK is increasing day by day that retains social capacity of this country inaccurately. In addition, Rademacher et al. [2] argued that more than 8,000 UK people are affected by pulmonary hypertension and dizziness is a common factor among them. In case of previous researches, particular age group has been selected and no concise information has been informed about necessity of modern drug therapies.

Pulmonary hypertension occurs when blood pressure becomes excessive in pulmonary veins and arteries. As a result, supply of oxygen in different body parts face a number of problems and respiratory rate reduces potentially. In addition, Pesto et al. [3] pointed out that oxygen deficiencies in pulmonary vein causes dizziness and shortness of breath. However, previous articles did not explain the necessity of Calcium chain blockers by comparing with Sildenafil. On the other hand, Panopoulos et al. [4] suggests that proper application process of Sildenafil drugs is not mentioned to any previous researches. Therefore, this research would try to shed light for comparing the therapeutic effect of Calcium chain blockers and Sildenafil for medical management of pulmonary hypertension. [Refer to appendix 1].

Figure 1: Flow Diagram

Objectives

The aim of this study is to develop knowledge about medical management of pulmonary hypertension by analysing effect of Calcium chain blockers and Sildenafil for its recovery.

• To develop the concept of medical management for pulmonary hypertension.
• To understand the therapeutic measures for Calcium chain blockers in case of pulmonary hypertension among UK
• To find out importance of Sildenafil as therapeutic drug to reduce vulnerability of pulmonary hypertension among UK
• To compare medical management processes of two different treatment schemes such as Calcium chain blockers and

Methods

Qualitative research method is followed for this study and various scientific journals are collected for elaborating data for this systemic review. All the articles are helpful to understand themes and concepts regarding heart disease named pulmonary hypertension.

Definition of research question

The research question for this study is about developing the concept of medical management for pulmonary hypertension. Random human models beyond age group, sex and race were considered to understand the effectivity of these drugs for human. On the other hand, this research topic was selected based on past literatures and prosper was used to formulate systemic review question.

Protocol

Agreement of PRISMA protocol was used for developing researchers understanding about this topic and data collection process was acquired. All the data were extracted by following PRISMA flow chart and checklist and ethical approval has been registered to reduce future contingencies [5].

Figure 2 shows flow diagram of this research and all the exclusion and inclusion criteria are selected based on particular topic. In case of this study, mainly keywords like Calcium chain blockers, Sildenafil and pulmonary hypertension were searched for data collection. Primarily, 28 articles were selected for meeting study category and 20 articles were selected further after removing duplicates. On the other hand, six records were excluded from this study and 10 articles were screened afterwards for better data proficiency. In addition, abstract of 10 articles were analysed previously based on study topic and finally 5 were identified for meeting all criteria. Therefore, quality-checking measures have been done to retrieve all the data regarding above-mentioned disease and its treatment processes.

Eligibility criteria

All the inclusion criteria for this review are enlisted below to deliver proper information about this topic.

More than 20 full text articles were selected previously for conduction of this study and the type were selected based on randomised controlled trails, pre-clinical trials and clinical trials. As per the opinion of Kim et al. [1], there is a huge difference between mode of action and side effects of Calcium Chain Blockers and Sildenafil.

Inclusion criteria

Human population has been selected for this research to find out effect of Calcium Chain Blockers and Sildenafil to treat pulmonary hypertension. Along with this, UK based data are selected for study purpose and journals on medical management are included. Therefore, all the papers were selected by reminding this theme and both the male and female participants were included for understanding medicinal value.

Exclusion criteria

Paper regarding potential heart diseases for animals other than human are excluded and therapies by using materials other Calcium chain blockers and Sildenafil are excluded. However, people who have used other drugs were excluded from this study as the theme lies to deliver importance of Calcium chain blockers and Sildenafil drugs for remedy purpose.

Information sources

The whole study was accomplished with the help of the articles retrieved from NCBI, PubMed and PMC websites. The researchers considered no unpublished articles during study progress and collection of data and their analysis.

Search Strategy

Last 5 years’ articles were selected and different phrases were searched to gain accurate article with high proficiency. The search was started from March 2020 and the date was 15^th March for acquiring information from articles. In addition, Boolean operators were used to search authentic articles for this study purpose.

Study selection

Selecting, sorting and organising of data have been acquired after primary and secondary screening and duplicates were removed for each article. Along with this, all the articles were selected after reading abstracts and screening has been done if abstracts were met the eligibility criteria.

Data collection process

Data has been collected from Google scholar, NCBI and other medical portal with the help of supervisor suggestions. On the other hand, selection of qualitative data was included population, control group, exposure group, and article year and exposure rate has been acquired.

Data items

All the data items were based on Calcium Chain Blockers and Sildenafil and mean scores is decided promptly for decision- making.

Risk of bias

Risk of bias was major for this research as individual researchers have focused on particular type of medicines whether Calcium Chain Blockers or Sildenafil. On the other hand, there was conflict between randomised control trials and clinical trials before reporting properly. In addition, articles with positive results were highlighted and underrated articles were not chosen for this review process.

Summary Measures

Summary of this study has been plotted in result section through flow diagram and graphs of subgroup analysis have been shown in a potential manner. All the statistical data was gathered properly by analysing graphs and confidential interval was supported correctly.

Synthesis of result

Ms-Excel was used for data synthesis, analysis, and all the data were documented authentically in a confidential software drive. On the other hand, all the data would forest plot to deliver proper information about medical management scheme of pulmonary hypertension by using Calcium Chain Blockers and Sildenafil.

Results

Table 2 has shown all the articles were focused on different study population and controlling of pulmonary hypertension was developed in a proper manner. Most of the articles were shown positive results and application of Calcium Chain Blockers and Sildenafil in order to reduce pulmonary hypertension. On the other hand, exposure and control group have been forecasted proficiently to develop better knowledge on this topic.

The above table 3 shows the demographic and health related data of the patients and the results from diagnostic tests are evaluated in a correct order.

This table 4 has shown change in physical health after application of Sildenafil and clear comparison about control group and study group is given.

This table 5 shows the differentiation about various groups after using drugs potential to pulmonary hypertension recovery.

Discussion
Interpretation of data

The aim of discussion of the study is to deliver accurate information by summarising the data from all selected papers. This section mainly focuses to develop better understanding why it is important to consider Calcium chain blockers and Sildenafil as modern therapeutic alternative of pulmonary hypertension.

This study has investigated the comparison between Calcium chain blockers and Sildenafil for reducing viability of pulmonary hypertension. On the other hand, several medical management schemes and opportunities have been elaborated from this study. Medical management is a process to insert modern therapeutics for reducing the probability of any potential disease. This study informs that Calcium chain blockers provide no side effect for patients suffering from pulmonary disorder. In addition, lack of calcium accumulation in blood vessel is an effective therapy to manage vulnerability of pulmonary hypertension. On the contrary, Goldstein et al. [6] commented that Sildenafil delivers number of negative side effects for patient’s body and disease management becomes difficult. In addition, congenital heart surgery can help to reduce negative impact of pulmonary hypertension among infants. Along with this, Arora et al. [7] pointed out that pulmonary crisis can be managed potentially and rate of morbidity and mortality can be managed accurately. Therefore, proper choice of treatment is necessary to decrease viability of this heart related contingencies and ventricular dysfunction has been controlled.

Summary of findings

This section of the study provides a clear overview about findings of selected journal articles by which importance of medical management can be understood. On the other hand, most of the part of this section is focused on deliverance of drugs name and its uses for better health condition.

This review has highlighted that mode of action of Calcium chain blockers and Sildenafil are very different but both of them are effective to reduce negative viability of pulmonary hypertension. On the other hand, data has been gathered from this research that oral consumption of Sildenafil is better for preoperative use to reduce rate of mortality among infants. As per the opinion of Farhat et al. [8], Calcium chain blockers are probably the first therapeutic subsidy to reduce vulnerability of pulmonary hypertension. Primarily, doctors have prescribed few common medicines such as Amlodipine, Nicardipine, Felodipin to control angina and blood pressure. In addition, Hoeper et al. [9] pointed out that, Calcium chain blockers helps to manage calcium accumulation in blood vessels. On the other hand, open up of blood vessels are important to supply sufficient amount of oxygen throughout the body. In addition, this vasodilator is a proficient one to deliver positive impact for idiopathic pulmonary hypertension therapy.

Calcium chain blockers are not suitable option for pregnant women due to some potential side effects. As pointed out by Perros et al. [10], thick uterus wall is needed for pregnant women but toxicity of Calcium chain blockers affects negatively on blood supply for foetus. Therefore, these long acting tablets are prohibited for pregnant women and doctors have restricted to prescribe medications for would be mothers. On the other hand, Zhang et al.

• Mentioned that headache, dizziness, flushing and swallowing ankle are the common disorders of Calcium chain blockers. By analysing 5 relevant articles and accomplishing in field study with 63 patients, data has been gathered that providing of proper dose is needed for these Apart from this, Lancaster and Zeid
• Suggested to take minimum dose twice a day for reducing viability of pulmonary hypertension. Both the tablets and capsules are helpful to manage pulmonary hypertension and heart rate can be controlled properly.

Sildenafil is an effective drug to control negative impact of pulmonary hypertension among infants. This drug shows quick action for disease reduction and a patient can be cured within 60 minutes to 4 hours. As per the opinion of Arora et al. [13], Sildenafil can be used as post-operative drug for the children suffering from complex heart diseases. On the other hand, sensitivity of right ventricle is increased by applying this drug orally for helping easy movement of blood from heart to lungs. Along with this, Krishnan et al. [14] commented that PDE5 activity is decreased by supplying Sildenafil and more cyclic GMP is produced within lungs. On the other hand, pulmonary blood pressure is decreased potentially for improving heart function and body balance can be controlled. Apart from this excessive breakdown of cGMP becomes facilitative for patients to acquire better stimulation and physical development can be acquired properly.

Previous researchers have informed that daily consumption of Sildenafil can deliver negative effect for human body and other organs have been affected badly. On the other hand, it is also reported by Almaaitah et al. [15], prolonged consumption of Sildenafil causes chronic disease. Painful erection at about 4 hours is dangerous for any human being and it becomes immediate to contact with doctors. Apart from this, Sildenafil affects negatively on gonaotrophic hormones and development of body parts has been ceased inaccurately. Along with this, Rosenzweig et al. [16] pointed out that, permanent eye blindness and vision decrement are common vulnerable side effects of Sildenafil. On the other hand, Viagra is an active component of this drug and this impact negatively on nervous system and body weakness can be occurred as a result. Apart from this, consumption of Sildenafil in high doses is vulnerable for metabolism and regular digestion of human being are affected potentially [17]. Therefore, use of Sildenafil as drug for pulmonary hypertension is still under trial for numerous side effects.

Calcium chain blockers and Sildenafil, both are vital drugs to reduce viability of pulmonary hypertension among human population. However, there is some major differences between applications and doses of these above-mentioned drugs. As per the opinion of Desai and Desouza [18], Sildenafil acts on molecular level and blood pressure level of an individual can be managed through this. On the other hand, Calcium chain blockers generally work over normal physiological functions and reduce calcium accumulation in blood vessels. In addition, Lan et al. [19] argued that Sildenafil acts quickly for reducing negative impact of pulmonary hypertension among patients. However, critical patients are generally operated by using Sildenafil as regular drug for reducing affectivity of pulmonary hypertension. On the other hand, viability of oxygen deficiency can be fixed in a correct manner by applying Sildenafil in hospitals. Therefore, morbidity rate for this body dysfunction can be reduced in a potential manner by applying this drug on a daily basis in proper dose.

Pulmonary hypertension therapy follows use of anticoagulant medicines in UK and doctors mainly try to prevent blood clots. As per the opinion of Solaimanzadeh [20], medical centres of UK to remove excess fluid from body generally use diuretics tablets and imbalance of oxygen can be maintained accurately. On the other hand, normal oxygen treatment is also accomplished to reduce potency of heart failures among patients. In addition, Fukuda et al. [21] pointed out that endothelin receptor antagonist is effective to treat vulnerability of pulmonary hypertension. On the other hand, molecular level treatment is also accepted for infants suffered by pulmonary hypertension. Apart from this, soluble cyclase stimulators are also used for regulating blood pressure of individual person and oxygen deficiency in lungs can be controlled. In addition, Calcium channel blockers are effective to control angina and accumulation of calcium ion in blood vessels can be reduced correctly.

Study limitation

This research has several limitations due to the small sample size and time limit of this study is not accurate in order [22]. As per the opinion of Bigdelian and Sedighi [23], money is important for any research to improve clarity and viability. In case of this research, money was a bigger problem and researchers became unable to extract actual data of this medical issue and disease management schemes. Along with this, review of all the articles have not accomplished properly because of time congestion and interpretation of all data became bias in nature. On the other hand, proper keywords have not been searched to gather information from relevant previous articles. Apart from this, Tamura et al. [24] mentioned that analysis of medical history of sample populations is necessary to adapt before continuing study with a particular set of participants. However, in case of this research, no relevant information about past medical factors of populations has been developed to acquire real field information.

Conclusion

Medical management of pulmonary hypertension is generally accomplished by using Calcium chain blockers and Sildenafil.

On the other hand, doctors have prescribed to use Calcium chain blockers on a daily basis rather than Sildenafil due to vulnerable side effects. However, Calcium chain blockers are not suggested for pregnant women as lack of calcium in blood vessels becomes problematic for foetus. Apart from this, critical patients suffering from pulmonary hypertension are treated by using Sildenafil as it provides quick actions. In addition, the above-mentioned drug becomes helpful to act in molecular level by using dose at about 0.3 mg/kg body weight. Left to right shunt of human ventricle is necessary to manage blood pressure level of a patient affected by pulmonary hypertension. Moreover, systemic review of articles and in field survey has shown result that optimal dosing of both the medicines help to obtain efficacy of disease and management of this chronic disorder becomes easy.

Ethical approval

This research has been accomplished under proper ethical regulations and rules of NLM and NHS have been maintained accurately. On the other hand, all the articles have acknowledged properly for reducing conflict of interest. Along with this, names and medical data of the patients are stored with high confidentiality and no information is shared with third party without the members of research team.

Completing interests

This systematic review is more relevant than any previous researches on this topic because researchers have compared action of major type of medicines using for pulmonary hypertension reduction. In addition, side effects for each of the drug are enlisted promptly in this review to forecast their usage and affectivity for patients. On the other hand, this study is a unique one to compare mode of actions of Calcium chain Blockers and Sildenafil. Researchers have fetched out data from various literatures to demonstrate clearly about drug application and its potency for medical management of pulmonary hypertension.

Acknowledgement

This systemic review would not be possible without active participation of all team members and professors have helped to select correct research article. All the researchers are grateful for professors and other medical authorities for their immense help in research conduction.

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