The Management of Mild Pulmonary Hypertension in Clinical Practice

Ann Am Thorac Soc. 2024 May 15. doi: 10.1513/AnnalsATS.202312-1079FR. Online ahead of print.

Abstract

The definition of pulmonary hypertension (PH) has been revised recently by lowering the mean pulmonary artery pressure (mPAP) threshold from ≥25 mmHg to >20mmHg, assessed by right heart catheterization (RHC). This change reflects the mPAP upper limit of normal and lower limit that is independently associated with adverse outcome. To improve the specificity of diagnosing pathogenic elevation in mPAP, however, classifying patients with precapillary PH now also includes pulmonary vascular resistance (PVR) >2.0WU (from >3.0WU). These changes are positioned to capture ~55% more patients with PH. Since all clinical trials showing benefit of pulmonary vasodilator therapy in precapillary PH used the classical hemodynamic definition, the approach to diagnosis and management of patients with mild PH (i.e., mPAP 21-24mmHg and PVR 2-3WU) requires particular consideration. Here, we use a question- answer format to discuss key areas in the management of mild PH, including practical information catered to clinicians without training in PH.