PULMONARY-HYPERTENSION IN DRUG-USERS

Pulmonary hypertension is common in drug users (8% in autopsy studies) but probably often escapes clinical diagnosis. Causes include effects of the drug itself or of contaminants, lower respiratory tract infections, vasculitis, and bronchial disorders. Several cases of HIV-related pulmonary hypertension have been reported. Regardless of the cause, alterations in the pulmonary endothelium responsible for defective regulation of pulmonary artery tone probably play a central role in the genesis of pulmonary hypertension. Management requires drug withdrawal and treatment of infections. Vasodilatators can be widely used. Use of anticoagulants and oxygen raises practical problems in drug users.