ABSTRACT Methamphetamine‐associated pulmonary arterial hypertension (Meth‐PAH) is an increasingly prevalent but understudied subtype of Group 1 pulmonary arterial hypertension (PAH). While most prevalent in the Western United States, its reach continues to expand with the evolving global methamphetamine epidemic. Despite its designation as a definite cause of PAH, there are no standardized diagnostic criteria or treatment guidelines specific to Meth‐PAH. This review summarizes its epidemiology, proposed pathophysiology, clinical management, and treatment challenges. We outline a pragmatic approach to Meth‐PAH, emphasizing structured screening for substance use, initiation of oral PAH‐specific therapies regardless of abstinence, and therapy escalation based on adherence and serial risk assessment. Key knowledge gaps include Meth‐PAH pathophysiology, performance of risk stratification tools, and the safety and efficacy of PAH therapies in patients with ongoing use. A multidisciplinary approach is needed to address both Meth‐PAH and methamphetamine use disorder to improve outcomes in this high‐risk, stigmatized population.
SOOD et al. (2026) studied this question.