University of São Paulo: Review of pulmonary arterial hypertension treatment by the SUS can improve patients’ lives


The recommended treatment protocol for patients with Pulmonary Arterial Hypertension (PAH) may be changed in the new version. The Unified Health System (SUS) indicates the prescription of monotherapy. However, the review of clinical procedures suggests the use of combination therapy from the onset of disease cases to improve the patient’s condition and reduce the severity of the disease.

The distinction between the protocols of the State of São Paulo and the rest of the country is a reason for reflection by specialists. While Brazil proposes taking a drug, doctors in São Paulo can follow the combination of drugs. For Rogério de Souza, professor of Pulmonology at the USP School of Medicine and pulmonologist at the Instituto do Coração (InCor) at Hospital das Clínicas, the implementation of national clinical guidelines allows “to optimize resources, treat a greater number of patients and make the drug available nationally. ”.

The regionalization of combined therapy for a disease that affects people from all over Brazil, who are dependent on the SUS, prevents access to treatment: “It is a huge difficulty for patients from outside the State of São Paulo to obtain medication and the protocol that is being revised it is, precisely, with ways to try to implement first-line combined therapy for the entire country”, elaborates the professor.

Attention to the diagnosis
PAH differs from hypertension, popularly known as “high blood pressure”. Souza compares: “The body’s vessels are more closed and, as a result, the heart has to exert more force for the blood to pass through it. This is the high blood pressure that we are used to. Pulmonary arterial hypertension is exactly the same thing, only in the vessels of the lung”. Faced with the narrowing of the vessels, the right ventricle is overloaded with the need to supply venous blood to the respiratory system.

Rare and severe, Pulmonary Arterial Hypertension defies medicine, with poorly detected symptoms and a high mortality rate. “Actually, the signs (of PAH) are very nonspecific and that is what makes the disease take time to be diagnosed”, says the professor. Given the severity, it requires a more aggressive combination of drugs so that they target the lungs specifically, “at least with dual combination therapy. That is, two medicines that you take orally”, he explains.

The professor recommends consulting clinicians when there is a feeling of limitation or shortness of breath during activities: “Pulmonary hypertension is not the main cause (of shortness of breath), we have much more frequent causes. But you also need to diagnose these causes to treat them properly.”

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