The article deals with the modern tactics of pulmonary hypertension therapy, used in case of unsatisfactory clinical response to previous therapy. All classes of pathogenetic therapy of pulmonary hypertension are presented, as well as modern views on the risk stratification of annual mortality of patients. Switching to a more effective drug both within one group of pathogenetic PAH-therapy, and to drugs of other classes is discussed. The latest classification of pulmonary hypertension (Nice, 2018) is presented.