The Management of Mild Pulmonary Hypertension in Clinical Practice

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 ≥25mm Hg to >20mm 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 21–24mm 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.

Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians

Learning Objectives

At the conclusion of this activity, learners should be able to:

  • Define pulmonary hypertension
  • Describe criteria that warrant referral to a pulmonary hypertension center
  • Identify strategies to manage the care of patients with mild pulmonary hypertension
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation
Publication Date: 
07/25/2024
Credit Expires: 
08/01/2026
Rating: 
0

This section is not in use.

Please visit the Accreditation tab to view Accreditation and Disclosure information.

Discloser List CME Internal Report

Accreditation Statement

The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Disclosure Declaration

Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

Katarina Zeder, M.D. (Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA; University of Maryland, School of Medicine, Baltimore, Maryland, USA) reported receipt of a Max Kade Fellowship outside of the current work. She has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events outside of the current work from Janssen, MSD, and Ferrer. She has received support for attending meetings and/or travel outside of the current work from MSD and Janssen.

Evan Brittain, M.D. (Vanderbilt University Medical Center Division of Cardiovascular Medicine, Nashville, Tennessee, USA) reported receipt of research grants from the National Institutes of Health and an investigator-initiated grant from United Therapeutics.

Gabor Kovacs, M.D. (Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria) reported receipt of grants or contracts from Boehringer Ingelheim, Janssen, and MSD. He has received consulting fees outside of the current work from Boehringer Ingelheim, Janssen, MSD, AstraZeneca, Chiesi, AOP, and Ferrer. He has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events outside of the current work from Boehringer Ingelheim, Janssen, MSD, AstraZeneca, Chiesi, AOP, and Ferrer. He has received support for attending meetings and/or travel outside the current work from AOP, Vitalaire, MSD, and Boehringer Ingelheim. He is President of the Austrian Society of Pulmonology and a member of the ERS Guideline Group.

Bradley A. Maron, M.D. (University of Maryland, School of Medicine, Baltimore, Maryland, USA) reported receipt of research grants from the National Institutes of Health, an investigator-initiated project from Deerfield Company, and an industry-initiated grant from Actelion Pharmaceuticals. He is a co-inventor and has a patent pending for an antibody that inhibits lung thrombosis. He is a co-inventor and holds a patent on a redox switch in a protein that controls blood pressure. He is a member of the advisory board of Tenax Therapeutics.

Off-Label Usage Disclosure

None

Disclosures of AnnalsATS CME Planners

The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.

The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.

AnnalsATS CME Planners

Margaret M. Hayes, M.D.
Harvard Medical School, Boston, MA, USA
Dr. Hayes reported receiving payments as an author for a chapter on heliox for UpToDate.
 
Caroline Okorie, M.D., M.P.H.
Stanford University School of Medicine, Stanford, CA, USA
Dr. Okorie reported no financial relationships with ineligible companies.

All relevant financial relationships have been reviewed and mitigated.

Instructions to Receive Credit

To receive credit for this journal article:

  1. Read the journal article. Keep track of how long it takes you to read it.
  2. Once you open the article, the Post-Test becomes available. After reading the article, answer the post-test questions. You must answer all questions correctly to earn credit. You may take the test as many times as you like.
  3. Once you pass the Post-Test, the Evaluation becomes available. Answer all the evaluation questions.
  4. Once you complete the evaluation, select the amount of credit to receive based on the time it took you to read the article.
  5. You can view, save and print your Certificate by pressing the Certificate button.
  6. To review the credits you've earned in this system and reprint certificates, go to the My Learning drop-down list. Then select Transcript.

Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation
Please login or register to take this course.

 

To start this learning activity, press the Take Activity button. Then follow the on-screen instructions.

The system keeps track of your progress. If you close the activity and resume it later, it will re-start where you left off.