Exaggerated hypoxic pulmonary vasoconstriction without susceptibility to high altitude pulmonary edema.

BACKGROUND: Abnormally high pulmonary artery pressure (PAP) in hypoxia due to exaggerated hypoxic pulmonary vasoconstriction (HPV) is a key factor for development of high-altitude pulmonary edema (HAPE). It was shown that about 10% of a healthy Caucasian population has an exaggerated HPV that is comparable to the response measured in HAPE-susceptible individuals. Therefore, we hypothesized that those with exaggerated HPV are HAPE-susceptible. METHODS AND RESULTS: We screened 421 healthy Caucasians naïve to high altitude for HPV using Doppler echocardiography for assessment of systolic PAP in normobaric hypoxia (PASPHx; Po2 corresponding to 4500 m). Subjects with exaggerated HPV and matched controls were exposed to 4559 m with an identical protocol that causes HAPE in 62% of HAPE-S. Screening revealed 39 subjects with exaggerated HPV, of whom 33 (PASPHx 51±6 mmHg) ascended within 24 hours to 4559 m. Four (13%) of them developed HAPE during the 48 h-stay. This incidence is significantly lower than the recurrence rate of 62% previously observed in HAPE-S in the same setting. None of the control subjects (PASPHx 33±5 mmHg) developed HAPE. CONCLUSION: An exaggerated HPV cannot be considered a surrogate maker for HAPE-susceptibility although excessively elevated PAP is a hallmark in HAPE, while a normal HPV appears to protect from HAPE in this study.

Safety data and beneficial effects of the combined oral contraceptive ethinylestradiol 0.03 mg/chlormadinone acetate 2 mg (Belara®): a 13-cycle, observational study in routine clinical practice.

BACKGROUND: The monophasic hormonal combined oral contraceptive (COC) ethinylestradiol (EE) 0.03 mg/chlormadinone acetate (CMA) 2 mg (Belara®) has been shown to have good long-term efficacy and tolerability. OBJECTIVES: The aim of this study was to corroborate the long-term safety of EE 0.03 mg/CMA 2 mg by evaluating the incidence and severity of adverse drug reactions (ADRs) and cycle control over 13 treatment cycles. Additionally, the influence of EE 0.03 mg/CMA 2 mg on dysmenorrhoea, acne and the well-being of subjects was also investigated. METHODS: This observational study was conducted in Spain, France and Italy from April 2006 to August 2008. Subjects of reproductive age, without contraindications mentioned in the current summary of product characteristics, were prescribed EE 0.03 mg/CMA 2 mg in routine clinical practice. RESULTS: 3771 subjects were analysed and at least one ADR was reported in 833 (22.1%) subjects, with the majority of ADRs (75.6%) being judged as mild or moderate. The most frequently reported ADRs were intermenstrual bleeding (7.7% of all analysed subjects), headache (5.1%) and breast pain (2.7%). Spotting and breakthrough bleeding (defined as slight and heavier intermenstrual bleeding) at baseline were reported by 677 (18.0%) and 268 (7.1%) subjects, but were less frequent in cycles 10-13 (9.6% and 1.7%, respectively). Before study start, 61.8% of subjects suffered from dysmenorrhea, with the intensity being moderate or severe in 66.9% of these subjects. In cycles 10-13, the corresponding values were noted in 15.0% and 25.6% of subjects. The proportion of subjects who suffered from acne decreased from 46.5% at study entry to 14.9% after 13 medication cycles. More than 50% of the subjects who had switched from another oral contraceptive (OC) pill stated that the tolerability of EE 0.03 mg/CMA 2 mg and their health-related well-being were much better or better after two cycles of EE 0.03 mg/CMA 2 mg than when they were taking their previous OC, and about 85% of the subjects assessed the tolerability of EE 0.03 mg/CMA 2 mg as very good or good during the study. CONCLUSION: These results re-affirmed the favourable ADR profile of the COC EE 0.03 mg/CMA 2 mg, as well as its good cycle control and beneficial effects on dysmenorrhoea, complaints typically occurring during the cycle, acne and well-being.