Overview of current therapeutic approaches for pulmonary hypertension

Abstract

There have been tremendous strides in the management of pulmonary hypertension over the past 20 years with the introduction of targeted medical therapies and overall improvements in surgical treatment options and general supportive care. Furthermore, recent data shows that the survival of those with pulmonary arterial hypertension is improving. While there has been tremendous progress, much work remains to be done in improving the care of those with secondary forms of pulmonary hypertension, who constitute the majority of patients with this disorder, and in the optimal treatment approach in those with pulmonary arterial hypertension. This article will review general and targeted medical treatment, along with surgical interventions, of those with pulmonary hypertension.

Keywords: pulmonary arterial hypertension; pulmonary hypertension; therapy; treatment.

Figure 1

Treatment Algorithm for PAH. Lower risk PAH constitutes those patients with no evidence of right heart failure, WHO II or III functional status, preserved 6MWD and minimally elevated natriuretic peptide levels. Higher risk PAH patients have clinical or hemodynamic evidence of right heart failure, WHO class IV functional status, short 6MWD or significantly elevated natriuretic peptide levels. (6MWD: six-minute walk distance; FC: functional class; CCB: calcium channel blocker; ETRA: endothelial receptor antagonist; PAH: pulmonary arterial hypertension; PDE5: phosphodiesterase 5 inhibitor; RHC: Right heart catheterization; TTE: transthoracic echocardiogram; WHO: World Health Organization).