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Pulmonary Arterial Hypertension: a Pharmacotherapeutic Update

  • Heart Failure (HJ Eisen, Section Editor)
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Abstract

Purpose of Review

Pulmonary arterial hypertension (PAH) leads to progressive increases in pulmonary vascular resistance (PVR), right heart failure, and death if left untreated. This review will summarize and discuss recent updates in the classification and management of patients with PAH.

Recent Findings

PAH requires careful hemodynamic assessment and is defined by a mean pulmonary artery pressure > 20 mmHg with normal left-sided filling pressures and a PVR ≥ 3 Wood units. Most patients with PAH require targeted pharmacotherapy based on multiparametric risk stratification. Significant improvements in clinical outcome have been realized through the approval of 14 unique pharmacotherapeutic options.

Summary

The latest clinical recommendations provide the updated hemodynamic definition and clinical classification as well as evidence-based treatment recommendations. An important change is the focus on initial upfront combination therapy for most patients with PAH. Structured follow-up and escalation of treatment for those not achieving low-risk status is paramount.

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Authors and Affiliations

  1. Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, UPMC Presbyterian Hospital, 727 Salk Hall, 3501 Terrace Street, Pittsburgh, PA, 15261, USA

    James C. Coons

  2. University of Michigan, Ann Arbor, MI, USA

    Kristen Pogue

  3. Gill Heart Institute, University of Kentucky, Lexington, KY, USA

    Andrew R. Kolodziej

  4. Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA

    Glenn A. Hirsch

  5. Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA

    Marjorie Patricia George

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James C. Coons reports a grant from United Therapeutics.

Kristen Pogue reports no conflicts of interest.

Andrew R. Kolodziej reports no conflicts of interest.

Glenn A. Hirsch reports no conflicts of interest.

Marjorie Patricia George reports a grant from Actelion, and personal fees from Actelion, Gilead, Bayer.

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Coons, J.C., Pogue, K., Kolodziej, A.R. et al. Pulmonary Arterial Hypertension: a Pharmacotherapeutic Update. Curr Cardiol Rep 21, 141 (2019). https://doi.org/10.1007/s11886-019-1235-4

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