{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:22:23Z","timestamp":1790767343813,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,9,4]],"date-time":"2019-09-04T00:00:00Z","timestamp":1567555200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007150","name":"United Therapeutics Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007150","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,9]]},"abstract":"\n Pulmonary hypertension (\n PH<\/jats:styled-content>\n ) is often caused by left heart disease (\n LHD<\/jats:styled-content>\n ) such as heart failure (\n HF<\/jats:styled-content>\n ) or valvular heart disease. Historically, few randomized controlled trials have evaluated the off\u2010label use of medications for treating pulmonary arterial hypertension (\n PAH<\/jats:styled-content>\n ) in patients with\n PH<\/jats:styled-content>\n \u2010\n LHD<\/jats:styled-content>\n . However, multiple randomized controlled trials have been published over the last decade that investigated their use in patients with\n PH<\/jats:styled-content>\n \u2010\n LHD<\/jats:styled-content>\n . In addition, recent updates in the classification and definitions of\n PH<\/jats:styled-content>\n have led to an improved recognition of\n PH<\/jats:styled-content>\n \u2010\n LHD<\/jats:styled-content>\n phenotypes, notably combined post\u2010capillary and pre\u2010capillary\n PH<\/jats:styled-content>\n and isolated post\u2010capillary\n PH<\/jats:styled-content>\n . In this systematic review, we show that\n PAH<\/jats:styled-content>\n medications should not be recommended in two distinct\n HF<\/jats:styled-content>\n populations: patients with\n HF<\/jats:styled-content>\n without definitive\n PH<\/jats:styled-content>\n diagnosis and patients with isolated post\u2010capillary\n PH<\/jats:styled-content>\n due to\n HF<\/jats:styled-content>\n . In addition, the use of bosentan or macitentan is not recommended in patients with combined post\u2010capillary and pre\u2010capillary\n PH<\/jats:styled-content>\n due to\n HF<\/jats:styled-content>\n , but sildenafil may be considered to improve pulmonary hemodynamics and exercise capacity in patients with combined post\u2010capillary and pre\u2010capillary\n PH<\/jats:styled-content>\n due to\n HF<\/jats:styled-content>\n . Riociguat 2\u00a0mg 3 times daily may also be considered to improve pulmonary hemodynamics in patients with combined post\u2010capillary and pre\u2010capillary\n PH<\/jats:styled-content>\n due to heart failure with reduced ejection fraction but not heart failure with preserved ejection fraction. The postoperative use of sildenafil in the setting of\n PH<\/jats:styled-content>\n after valvular heart disease intervention was evaluated. Limited clinical data and safety concern warrants caution with the postoperative use of sildenafil in patients with\n PH<\/jats:styled-content>\n due to valvular heart disease. Despite recent advances in the understanding of\n PAH<\/jats:styled-content>\n medications for patients with\n PH<\/jats:styled-content>\n \u2010\n LHD<\/jats:styled-content>\n , uncertainty remains about their utility in distinct subgroups. Nonetheless,\n PAH<\/jats:styled-content>\n pharmacotherapy should generally be avoided for most patients with\n PH<\/jats:styled-content>\n \u2010\n LHD<\/jats:styled-content>\n .\n <\/jats:p>","DOI":"10.1002\/phar.2314","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T17:38:36Z","timestamp":1564162716000},"page":"929-945","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Efficacy and Safety of the Use of Pulmonary Arterial Hypertension Pharmacotherapy in Patients with Pulmonary Hypertension Secondary to Left Heart Disease: A Systematic Review"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3393-8025","authenticated-orcid":false,"given":"Kazuhiko","family":"Kido","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy West Virginia University School of Pharmacy Morgantown West 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