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Review
. 2016 Aug 9;188(11):804-812.
doi: 10.1503/cmaj.151075. Epub 2016 May 2.

Pulmonary hypertension: diagnostic approach and optimal management

Nathan Hambly  1 , Fahad Alawfi  1 , Sanjay Mehta  2
Affiliations
Review

Pulmonary hypertension: diagnostic approach and optimal management

Nathan Hambly et al. CMAJ. .
No abstract available

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Figures

Figure 1:
Figure 1:
Stepwise approach to managing pulmonary arterial hypertension (PAH) at Canadian expert centres, starting from bottom of the pyramid (based on the evidence described in Box 1). *Recommended only for patients whose pulmonary arterial hypertension meets specific criteria (idiopathic, heritable or drug-induced) and is identified as responsive to vasodilators by acute vasoreactivity testing during right-heart catheterization. †Options are phosphodiesterase type 5 inhibitors (PDE-5i; sildenafil, tadalafil) and soluble guanylate cyclase stimulators (sGC-S; riociguat), which improve signalling through the nitric oxide pathway; endothelin receptor antagonists (ERAs; bosentan, ambrisentan, macitentan), which block the action of endothelin-1; and a prostacyclin receptor agonist (selexipag), which addresses endogenous prostacyclin deficiency. Dual oral targeted combination therapy consists of one medication from the ERA family and another medication from either the PDE-5i family or the sGC-S family. ‡Options include the synthetic prostacyclin analogues epoprostenol (intravenous) and treprostinil (intravenous or subcutaneous). NYHA-FC = New York Heart Association functional class, PH = pulmonary hypertension.
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