Pulmonary hypertension: diagnosis and management

Abstract

#### Summary points Pulmonary hypertension was previously considered a rare untreatable condition. The past two decades have seen major changes in our understanding of the spectrum of disease affecting the pulmonary circulation. More than 30 randomised controlled trials (RCTs) of treatments have been performed, and surgery for patients with chronic thromboembolic pulmonary hypertension has been developed. Advances in imaging have enabled more detailed patient assessment, but pulmonary hypertension continues to be a life shortening condition, and there is often a delay of around two years from onset of symptoms to diagnosis.1 This article focuses on adult pulmonary hypertension in primary and secondary care, its diagnosis, and management. #### Sources and selection criteria This review is based on our personal experience, personal archives of references, and a PubMed search using terms including pulmonary hypertension, chronic thromboembolic disease, and prognosis. We consulted international guidelines from the European Society of Cardiology, European Respiratory Society, and American College of Chest Physicians. Pulmonary hypertension is defined at cardiac catheterisation as a mean pulmonary artery pressure of 25 mm Hg or more. The initial clinical classification in 1973 arose from a World Health Organization sponsored international meeting after an epidemic related to use of …