Pulmonary arterial hypertension in the elderly population

Abstract

Pulmonary arterial hypertension (PAH) was a disease predominantly affecting young females about 40 years ago; however, it has been increasingly diagnosed in elderly individuals. Few studies have investigated the features of elderly patients with PAH. This review provides an overview of the characteristics of elderly patients with PAH compared to young patients. The examination of the changing demographics of the population with PAH revealed that the mean age has increased over the years. In addition, the investigation into the diagnostic challenges in elderly patients with PAH revealed the difficulty in differentiating PAH from pulmonary hypertension secondary to diastolic heart failure. Moreover, it was noted that elderly patients underwent combination drug regimens less frequently and exhibited poorer treatment responses than young patients. Finally, it was found that elderly PAH patients experienced poorer survival than young patients. The differences among five survival prediction models and their applicability in predicting the prognosis of PAH patients are discussed.

Fig. 1

Difference in the percentage of patients undergoing combination therapy or other specific therapies targeting pulmonary arterial hypertension (PAH) between elderly and young patients with PAH. As shown in the figure, more young PAH patients underwent combination therapy or other specific therapies targeting PAH such as calcium channel blocker, prostaglandin, and organ transplantation, than elderly PAH patients. Although some of the differences in the percentage of patients undergoing these therapies between the young and elderly groups were not statistically significant, the percentage of patients undergoing combination therapies or other specific therapies in the young group was higher than that in the elderly group. Asterisk (*) indicates a statistically significant-difference (that is, p < 0.05) in the percentage of patients undergoing combination therapy or other specific therapies targeting PAH between elderly and young patients with PAH. a, Data reproduced from Ling Y, et al. Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland. Am J Respir Crit Care Med 2012; 186: 790-6. b, The bars in this group indicate the percentage of patients receiving combination therapy at a specific time (at diagnosis, and at 1, 2, and 3 years after diagnosis). Data reproduced from Hoeper et al. Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: results from the COMPERA registry. Int J Cardiol 2013; 168: 871-80. c, Data reproduced from Hjalmarsson C, et al. Impact of age and comorbidity on risk stratification in idiopathic pulmonary arterial hypertension. Eur Respir J 2018; 51.