Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the most common subsets of precapillary pulmonary hypertension with a prevalence of 50 individuals per million in Europe. The recent RACE study in patients who were no candidates for surgical pulmonary endarterectomy has shown that balloon pulmonary angioplasty (BPA) is superior to medical treatment alone, emphasising the mechanical disease component .
Primary treatment of CTEPH is surgical pulmonary endarterectomy for suitable patients, but treatment for those not eligible for surgery remains an unmet need. The RACE trial has prospectively compared the efficacy of oral riociguat, a stimulator of soluble guanylate cyclase, with BPA, an interventional technique using balloons to break intravascular obstructions and to restore flow. At 26 weeks, after randomisation of 105 patients (53 patients were assigned to riociguat and 52 were assigned to BPA), the primary endpoint geometric mean pulmona...
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