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Pulmonary arterial blood pressure is the force the right side of the heart needs to overcome to push blood to the lungs. Pulmonary hypertension (PH) is a higher pressure than normal. It will make it harder for the right side of the heart to pump blood.
If PH is left untreated it can lead to heart failure. The right side of the heart will no longer be able to pump enough blood. There are five different groups of PH.
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PH happens when blood flow through the lungs becomes more difficult. Many things can affect blood flow such as:
- The size of blood vessels—they can tighten and shrink the pathway for blood
- Thickened walls of blood vessels—damaged or inflamed blood vessels can make it hard for blood to flow through
- Blockages in blood vessels—such as blood clots
- Lung tissue damage—can decrease number of blood vessels
- Health problems that affect blood thickness
These changes are often the result of other illness or health issues. Sometimes it is not clear why these changes happen. PH causes can also vary by type of PH:
- Group 1 may not have a known cause. Known causes include:
- Group 2 PH is caused by problems on the left side of the heart such as:
- Group 3 PH may be caused by lung disease or other problems that cause low oxygen levels such as:
- Group 4 is caused by chronic blood clots that fail to resolve.
Group 5 PH is caused by other conditions. Examples include:
- Body wide illness such as vasculitis or sarcoidosis . They can affect blood vessels and lungs.
- Blood related illnesses that increase thickness and flow of blood such as
Metabolic illness such as:
- Thyroid disease
- Glycogen storage disorder
- Chronic renal failure
Factors that may increase your chance of pulmonary hypertension include:
- Having one of conditions listed above
- Family history of PH
- Home at high altitude (over 10,000 feet)
- Use of street drugs such as cocaine
There may be no symptoms in early PH. It may take years until any appear. Common symptoms include:
- Shortness of breath that continues to get worse over time
- Chronic fatigue
- Fainting spells
- Ankle swelling from fluid retention
- Chest pain
Your doctor will ask about your symptoms and past health. You may also be asked about your family’s health history. A physical exam will be done. The doctor may suspect PH based on your symptoms and exam.
Tests to confirm PH may include:
To look for the cause of PH, your doctor may also do one or more of the following:
- Blood tests
- Measure of oxygen and carbon dioxide in the blood—can be done with blood gas test or oximeter on finger
- Chest x-ray
- CT scan
- Ventialtion-perfusion scan
- Pulmonary function test
- Sleep study or overnight oxygen measurements
To see how much PH has affected your physical activity, you doctor may order:
- Six-minute walk test
- An exercise stress test
Treatment will depend on the cause and severity of PH. When possible the cause of PH is treated. Treating the cause will treat the PH. Treatment that may help to manage any type of PH includes:
- Diuretics—decrease fluid buildup in body
- Blood thinning medicine—to prevent formation of new blood clots
- Oxygen therapy—to increase amount of oxygen in the blood
- Physical activity—may improve symptoms
PH that has no known cause may need more care. Treatment can help to slow the progress of PH and growth of other problems. Options include:
Medicine can help to open blood vessels. This will ease pressure and improve blood flow. Some may also make it easier to be active and breathe. Options include:
- Calcium channel blockers
- Phosphodiesterase inhibitors
- Endothelin receptor blockers
- Stimulators of soluble guanylate cyclase
- Prostacyclin receptor antagonist
A lung transplant may be needed if other care does not work. It is only considered after all other options are tried and PH has become severe.
Not all PH can be prevented. Managing related conditions may help. Other steps include:
- Avoid use of street drugs like cocaine.
- Maintain proper weight. Weight may increase risk of certain types of PH.
- Talk to your doctor before using weight loss medicine or supplements. Some of these may cause PH.
- Do not smoke . Smoking increases risk of lung disease such as COPD.
American Heart Association
National Library of Medicine
Heart and Stroke Foundation of Canada
Kiely DG, Elliot CA, Sabroe I, Condliffe R. Pulmonary hypertension: diagnosis and management. BMJ. 2013 Apr 16. Accessed September 21, 2018.
Pulmonary hypertension classification and treatment. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905845/Pulmonary-hypertension-classification-and-treatment . Updated May 2, 2018. Accessed September 19, 2018.
Pulmonary Hypertension. NIH National Heart, Lung, and Blood institute website. Available at: https://www.nhlbi.nih.gov/health-topics/pulmonary-hypertension. Accessed September 19, 2018.
Simonneau G, Gatzoulis MA, Adatia I, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D34-41. Accessed September 21, 2018.
Taichman DB, Ornelas J, Chung L, et al. Pharmacological Therapy for Pulmonary Arterial Hypertension in Adults: CHEST Guideline. Chest 2014 Aug 1;146(2):449. Accessed September 21, 2018.
- Reviewer: Michael J. Fucci, DO, FACC
- Review Date: 09/2018
- Update Date: 09/21/2018