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
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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.
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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.
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Available Credit
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