Why the study?
Because clinical trials showing benefit of pulmonary vasodilator therapy used classical definitions, the management of patients meeting revised criteria for mild pulmonary hypertension requires particular consideration.
How should patients with mild pulmonary hypertension be diagnosed and managed in clinical practice following the revised hemodynamic definition?
How should patients with mild pulmonary hypertension be diagnosed and managed in clinical practice following the revised hemodynamic definition?
This review provides practical guidance on the diagnosis and management of patients with mild pulmonary hypertension following recent revisions to the hemodynamic definition of the disease.
The revised PH definition (mPAP >20 mm Hg plus PVR >2 WU) may refine diagnosis in select patients; leaves open need for outcome validation before broad adoption.
The definition of pulmonary hypertension (PH) has been revised recently, with the mean pulmonary artery pressure (mPAP) threshold (assessed by right heart catheterization) reduced from ⩾25 mm Hg to >20 mm Hg. This change reflects the mPAP upper limit of normal and a lower limit that is independently associated with adverse outcomes. To improve the specificity of diagnosing pathogenic increases in mPAP, however, a diagnosis of precapillary PH now also includes pulmonary vascular resistance >2.0 Wood units (WU) (lowered from >3.0 WU). These changes are positioned to capture approximately 55% more patients with PH. Because all clinical trials showing a benefit of pulmonary vasodilator therapy in precapillary PH used the classical hemodynamic definition, the approach to the diagnosis and management of patients with mild PH (i.e., mPAP 21-24 mm Hg and pulmonary vascular resistance 2-3 WU) requires particular consideration. Here, we use a question/answer format to discuss key areas in the management of mild PH, including practical information tailored to clinicians without training in PH.
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Zeder et al. (2024) studied this question.
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