Significant advances have been made in the management of pulmonary arterial hypertension (PAH) in the past decade. There is a greater understanding of the disease process, more robust markers of prognostication and a wider range of disease-targeted therapies, with three classes of drug therapy now established. This has resulted in improved prognosis and quality of life but has also increased the complexity in making treatment decisions. To utilise these pharmacotherapies to their best potential, several factors need to be considered. This article will discuss how best to initiate and escalate PAH therapy on an individual patient basis by discussing current pharmacotherapies available, specific patient factors and determining treatment response and prognosis at diagnosis and during follow-up.