Indonesian researchers have discovered that a combination of sildenafil and beraprost significantly increased the health-related quality of life (HRQoL) of patients with pulmonary arterial hypertension (PAH) and uncorrected secundum atrial septal defect (ASD), compared to sildenafil alone, according to a study published in the Heart Science Journal.

One of the causes of PAH is a left-to-right shunt caused by unrepaired ASD. “ASD patients who developed PAH could have symptoms that reduce their quality of life, such as dyspnea on effort, hemoptysis, dizziness, chest pain, palpitation, and peripheral edema,” Martini et al wrote.

These symptoms can affect patients’ HRQoL, which can be measured in a validated, repeatable, and specialized questionnaire known as the Short-Form 36 Health Survey (SF-36). 

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Sildenafil is an oral phosphodiesterase type-5 inhibitor, while beraprost is an oral prostacyclin analog; they both result in vasodilation.

A study investigating the effects of sildenafil and epoprostenol (an intravenous prostacyclin analog) demonstrated synergistic effects. The research team hence set out to investigate whether the combination of sildenafil and beraprost would likewise improve HRQoL in adult PAH patients with uncorrected secundum ASD. 

They carried out a prospective cohort study of 44 PAH patients with that specific disorder at the Universitas Brawijaya in Indonesia. Group A patients (n=24) received oral sildenafil 40 mg 3 times daily and oral beraprost 20 mcg twice daily, while Group B patients (n=20) received sildenafil only. Participants were asked to fill in the SF-36 form before and after 12 weeks of therapy to determine the effects of these medications on their HRQoL.

The researchers reported a significant increase in the HRQoL of patients in Group A compared to Group B in parameters such as physical function, physical limitation, fatigue, and pain. They thus concluded that the combination therapy of sildenafil and beraprost is superior to sildenafil alone in the patient group studied. 


Martini H, Fadlan MR, Nurudinulloh AI. The combination of oral PDE5-inhibitor (sildenafil) and oral prostacyclin analogue (beraprost) therapy for increasing quality of life in adults with pulmonary arterial hypertension related to uncorrected secundum atrial septal defect. Heart Sci J. Published online November 4, 2021. doi:10.21776/ub.hsj.2021.002.04.5