Key result
Lowering the pulmonary hypertension mPAP threshold to >20 mmHg is supported by increased mortality risk.
Why the study?
The 6th World Symposium on Pulmonary Hypertension proposed lowering the mean pulmonary artery pressure threshold defining pulmonary hypertension from ≥ 25 to > 20 mmHg, prompting review of the historical context, evolution, and rationalizing data.
Does lowering the mPAP threshold to > 20 mmHg identify patients at increased risk of mortality and progression to overt pulmonary hypertension?
Does lowering the mPAP threshold to > 20 mmHg identify patients at increased risk of mortality and progression to overt pulmonary hypertension?
The proposed lowering of the mPAP threshold to > 20 mmHg for defining pulmonary hypertension is supported by data showing increased mortality and disease progression in patients with mildly elevated mPAPs, though therapeutic implications remain unclear.
Does not yet warrant reclassifying mPAP 21–24 mmHg patients; leaves open whether threshold change improves risk stratification or outcomes.
PURPOSE OF REVIEW: The 6th World Symposium on Pulmonary Hypertension (WSPH) proposed lowering the mean pulmonary artery pressure (mPAP) threshold that defines pulmonary hypertension from ≥ 25 to > 20 mmHg. The historical context and evolution of the pulmonary hypertension definition and the data used to rationalize recent changes are reviewed here. RECENT FINDINGS: There are accumulating data on the clinical significance of mildly elevated mPAPs (21-24 mmHg). Studies have demonstrated lower exercise capacity and an increased risk of progression to overt pulmonary hypertension (mPAP ≥ 25 mmHg) in specific at-risk patient populations. Further, large registries across diverse pulmonary hypertension populations have identified increased mortality in patients with mPAPs 21-24 mmHg. Although the clinical sequelae of lowering the mPAP threshold remain unclear, this uncertainty has fueled recent debates within the pulmonary hypertension community. SUMMARY: The changes to the pulmonary hypertension definition proposed by the 6th WSPH are supported by normative hemodynamic data in healthy individuals as well as studies demonstrating an association between mPAPs above this normal range and increased mortality. Whether the higher mortality observed in patients with mildly elevated mPAPs is directly attributable to pulmonary vascular disease that is amenable to therapeutic intervention remains to be determined.
No takes yet. Share an insight, caveat, or question.
Brusca et al. (2020) conducted a review in Pulmonary hypertension. Lowering mean pulmonary artery pressure threshold to > 20 mmHg vs. Historical threshold of ≥ 25 mmHg was evaluated. Lowering the mean pulmonary artery pressure threshold for pulmonary hypertension from ≥25 to >20 mmHg is supported by normative data and associations with increased mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: