Which treatment approach for initial therapy of pulmonary artery hypertension (PAH) was associated with improved clinical outcomes according to recent trials?

The selection of combination therapy of endothelin receptor antagonists and phosphodiesterase inhibitors is supported by clinical trials which suggest that this approach can lead to better clinical outcomes in patients with pulmonary artery hypertension (PAH). Recent studies have shown that using multiple therapeutic agents can effectively target different pathways involved in the pathophysiology of PAH, thereby enhancing the overall effectiveness of treatment.

Combining these two classes of medications helps in the reduction of pulmonary vascular resistance more than monotherapies can achieve. Endothelin receptor antagonists work by blocking the effects of endothelin-1, a potent vasoconstrictor, while phosphodiesterase inhibitors serve to increase levels of cyclic guanosine monophosphate (cGMP), leading to vasodilation and reduced platelet aggregation. This synergistic effect improves hemodynamics and functional capacity, and is reflected in improved symptom control and quality of life for patients.

Monotherapy options, such as sildenafil or endothelin receptor antagonists, may provide benefits but do not harness the full potential of combination therapy. Additionally, while combination therapy of prostacyclin and nitrates could theoretically provide benefits, it is often limited due to safety concerns and potential side effects, which might not yield the