Pulmonary hypertension
oct 2014 · SICS Editore
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Pulmonary hypertension (PH) denotes a state where the mean pulmonary artery pressure is 25 mmHg or higher (measured invasively via right heart catheterisation in specialist medical care). In clinical practice, echocardiography is used as a screening tool because it provides the means to indirectly estimate the pressure within the pulmonary arteries. The most common causes of increased pulmonary blood pressure are problems related to the left side of the heart (such as ventricular failure and valvular defects) and hypoxaemia caused either by lung disease or other conditions (such as COPD, pulmonary fibrosis and sleep apnoea). In these situations the increase in pulmonary blood pressure is a secondary haemodynamic phenomenon and, according to current understanding, it only plays a minor role as far as the management of the condition is concerned. At present, no evidence exists on the benefit of PH medication in the treatment of these conditions. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are markedly rarer causes of PH, and in these conditions both pulmonary blood pressure and pulmonary vascular resistance play a major role. The principal mechanism behind PAH is an endothelial dysfunction in the small pulmonary arteries leading to an imbalance between vasoactive mediators (e.g. prostacycline, nitrous oxide and endothelin), which are responsible for the dilatation and constriction of the vessels as well as for enhancing or inhibiting vascular proliferation. Promising new drugs have been introduced during the last few years for the treatment of PAH, which improve the patient’s functional capacity and probably also the prognosis. The investigations of PH are always carried out in specialist medical care, and the diagnosis and treatment of PAH and CTEPH should be concentrated in specialist centres.
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