Pulmonary hypertension

Q:I am a 58-year-old woman with pulmonary hypertension (blood clots in the lungs). I am at my wit's end. My doctors have virtually given up on me, suggesting extreme measures such as transplants or risky operations. Do you know of any alternatives

A:Specialists favour transplantation as the ultimate treatment for primary pulmonary hypertension (PPH). But even when they do, the procedure need not be the standard, and radical, double-lung transplant. One specialist, J R Maurer from Cleveland, discovered that single-lung transplants were just as effective in the majority of his PPH patients (Lancet, 1996; 347: 1542).

But there's plenty going on in medicine even in the orthodox camp to suggest that a transplant should be a very last resort.

As always, the cure can be found by understanding the cause. Only about 6 per cent of PPH cases are genetic, so there is a reasonable chance that your condition was brought on by an outside factor. The most likely cause is the family of slimming pills known as serotonin reuptake inhibitors (Lancet, 1996; 347: 1321) which have been linked to the condition.

But that is not the whole picture. Not everyone who takes the pills goes on to develop PPH, nor has every PPH victim taken the drug. Tim Higginbottom from Sheffield University, England, has done some research into PPH, and has found that virtually all patients are deficient in some of the body's basic defences against heart and blood problems. Primarily they are lacking in prostacyclins and nitric oxide, both agents known as vasodilators which widen or relax the blood vessels. These, in turn, are produced and sustained by a layer of cells known as the endothelium. Professor Higginbottom has found that continuous intravenous injections of prostacyclin has improved the quality of life and survival in even the most advanced cases of PPH.

His findings were reported to the 92nd American Lung Association and American Thoracic Society International Conference held in New Orleans in May, 1996.

Prostacyclin, a prostaglandin or fatty acid, seems to be a key element. Epoprostenol, a prostacyclin "lookalike", lowers pulmonary pressure and prolongs survival in PPH sufferers (J Am Coll Cardiol, 1997; 30: 343-9). In one study involving 18 PPH patients from the New York area, the pressure in the right ventricular fell markedly, from 84.1 mm Hg to 62.7 mm Hg, when they were given continuous intravenous infusion. The prostacyclin patients have a much higher survival rate than others; their one, two and three year survival rates were 80 per cent, 76 per cent and 49 per cent respectively.

Experiments with nitric oxide have been tried on newborns with PPH (N Eng J Med, 1997; 336: 597-604). Mortality levels were similar between those given the nitric oxide and those not given the treatment. However, earlier studies suggested that nitric oxide can help in severe cases of PPH (Lancet, 1992; 340: 819-20 and 818-9). The researchers of the latest study concluded that it was safe and easy to use.

Turning to the holistic camp, WDDTY panel member Dr Leo Galland from New York reports that Dr Sid Baker, an American nutritionist, successfully treated one PPH patient with intravenous infusions of magnesium chloride, which dilates pulmonary arteries. Dr Galland also suggests you might try high doses of EPA a fatty acid principally found in oily fish garlic or the herb gingko biloba for their anti-platelet effects.

Chelation therapy might also be considered. It has been used since the 1950s, but it has been regulated by America's Food and Drug Administration only for the removal of toxic metals, such as lead and mercury, from the bloodstream. Its more popular use, for unclogging the arteries of heart patients, remains controversial.

Chelation involves up to 30 intravenous infusions of an amino acid, EDTA (ethylene diamine tetra-acetic acid). EDTA acts like a Hoover, sucking up artery-clogging calcium deposits as it goes through the blood, but chelation practitioners also emphasize the importance of a change in lifestyle to accompany the treatment, including optimum diet, exercise and stress-reducing techniques.

In one unpublished study, 87 per cent of 22,502 chelation patients reported improvements after treatment.

However, EDTA can cause kidney failure. During the mid-1970s, the deaths of 13 heart patients at a US hospital were linked with this therapy. For a fuller account of chelation therapy see WDDTY vol 4 no 2 and vol 4 no 9.

But if their therapy is controversial, the advice of the chelation therapists about lifestyle changes is indisputable. Many studies, far too numerous to mention here, have proved that a diet rich in fresh fruit and vegetables can improve heart disease, especially if you cut out sugar and processed foods. Garlic and vitamin E in particular have helped heart sufferers, and one study that echoes the advice of Dr Galland discovered that heart disease patients had a daily magnesium intake that was 12 per cent lower than those with no heart symptoms (Lancet, 12 August 1992).