Learn About Pulmonary Hypertension

What is the definition of Pulmonary Hypertension?

Pulmonary hypertension is high blood pressure in the arteries of the lungs. It makes the right side of the heart work harder than normal.

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What are the alternative names for Pulmonary Hypertension?

Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary hypertension; Cor pulmonale - pulmonary hypertension

What are the causes of Pulmonary Hypertension?

The right side of the heart pumps blood through the lungs, where it picks up oxygen. Blood returns to the left side of the heart, where it is pumped to the rest of the body.

When the small arteries (blood vessels) of the lungs become narrowed, they cannot carry as much blood. When this happens, pressure builds up. This is called pulmonary hypertension.

The heart needs to work harder to force the blood through the vessels against this pressure. Over time, this causes the right side of the heart to become larger. This condition is called right-sided heart failure, or cor pulmonale.

Pulmonary hypertension may be caused by:

  • Autoimmune diseases that damage the lungs, such as scleroderma and rheumatoid arthritis
  • Birth defects of the heart
  • Blood clots in the lung (pulmonary embolism)
  • Heart failure (of the left side of the heart)
  • Heart valve disease
  • HIV infection
  • Low oxygen levels in the blood for a long time (chronic)
  • Lung disease, such as COPD or pulmonary fibrosis or any other severe chronic lung condition
  • Medicines (for example, certain diet drugs)
  • Obstructive sleep apnea

In rare cases, the cause of pulmonary hypertension is unknown. In this case, the condition is called idiopathic pulmonary arterial hypertension (IPAH). Idiopathic means the cause of a disease is not known. IPAH affects more women than men.

If pulmonary hypertension is caused by a known medicine or medical condition, it is called secondary pulmonary hypertension.

What are the symptoms of Pulmonary Hypertension?

Shortness of breath or lightheadedness during activity is often the first symptom. Fast heart rate (palpitations) may be present. Over time, symptoms occur with lighter activity or even while at rest.

Other symptoms include:

  • Ankle and leg swelling
  • Bluish color of the lips or skin (cyanosis)
  • Chest pain or pressure, most often in the front of the chest
  • Dizziness or fainting spells
  • Fatigue
  • Increased abdominal size
  • Weakness

People with pulmonary hypertension often have symptoms that come and go. They report good days and bad days.

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What are the current treatments for Pulmonary Hypertension?

There is no cure for pulmonary hypertension. The goal of treatment is to control symptoms and prevent more lung damage. It is important to treat medical disorders that cause pulmonary hypertension, such as obstructive sleep apnea, lung conditions, and heart valve problems.

Many treatment options for pulmonary arterial hypertension are available. If you are prescribed medicines, they may be taken by mouth (oral), received through the vein (intravenous, or IV), or breathed in (inhaled).

Your provider will decide which medicine is best for you. You will be closely monitored during treatment to watch for side effects and to see how well you are responding to the medicine. DO NOT stop taking your medicines without talking to your provider.

Other treatments may include:

  • Blood thinners to reduce the risk of blood clots, especially for some forms of pulmonary hypertension
  • Oxygen therapy at home
  • Lung transplant, or in some cases, heart-lung transplant, if medicines do not work

Other important tips to follow:

  • Avoid pregnancy.
  • Avoid heavy physical activities and lifting.
  • Avoid traveling to high altitudes.
  • Get a yearly flu vaccine, as well as other vaccines such as the pneumonia vaccine, and the COVID vaccine.
  • Stop smoking.
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What is the outlook (prognosis) for Pulmonary Hypertension?

How well you do depends on what caused the condition. Medicines for IPAH may help slow the disease.

As the illness gets worse, you will need to make changes in your home to help you get around the house.

For patients with severe disease, lung transplant, or in some cases, heart-lung transplant can be considered.

When should I contact a medical professional for Pulmonary Hypertension?

Contact your provider if:

  • You begin to develop shortness of breath when you are active
  • Shortness of breath gets worse
  • You develop chest pain
  • You develop other symptoms
  • You feel lightheaded or dizzy
  • You have persistent palpitations
Respiratory system
Primary pulmonary hypertension
Heart-lung transplant - series - Normal anatomy
What are the latest Pulmonary Hypertension Clinical Trials?
A Randomized, Double-blind, Placebo-Controlled, Dose Escalation Study to Assess Safety, Efficacy and Pharmacokinetics of GMA301 in Subjects With Pulmonary Arterial Hypertension

Summary: A Randomized, Placebo-Controlled, Double-blind, Dose Escalation Study to Assess Safety, Efficacy and Pharmacokinetics of GMA301 Injection in Subjects with Pulmonary Arterial Hypertension

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Non-Invasive Evaluation of Right Ventricular - Pulmonary Arterial Coupling in Children With Elevated Pulmonary Vascular Resistance

Summary: The right ventricular (RV) systolic function is a key determinant of outcome in patients with pulmonary hypertension and elevated pulmonary vascular resistance. As the pulmonary artery pressure and vascular resistance increase (i.e. RV afterload) in these patients, so does the right ventricular contractility in an attempt to maintain cardiac output. This is response of a ventricle to its afterload...

What are the Latest Advances for Pulmonary Hypertension?
Real-world evidence of subcutaneous treprostinil use in pulmonary arterial hypertension in Argentina.
Evidence base for specific pulmonary vasodilators in adults with congenital heart disease.
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Chronic thromboembolic pulmonary hypertension: from pathogenesis to the choice of treatment tactics.
Who are the sources who wrote this article ?

Published Date: January 20, 2022
Published By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Lammi MR, Mathai SC. Pulmonary hypertension: general approach. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 83.

Maron BA. Pulmonary hypertension. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 88.