Management of patients with pulmonary hypertension : guidelines for students and interns

Abstract

Pulmonary hypertension (PH) is defined as an increase in mean pul-monary arterial pressure (PAPm) ≥25 mmHg at rest as assessed by right heart catheterization (RHC). Available data have shown that the normal PAPm at rest is 14+3 mm Hg with an upper limit of normal of approximately 20 mm Hg. The clinical significance of a PAPm between 21 and 24 mm Hg is unclear. Patients presenting with a pulmonary artery pressure (PAP) in this range should be carefully followed when they are at risk for developing PAH [e.g. patients with connective tissue disease (CTD) or family members of patients with heritable PAH (HPAH)]. Due to the lack of reliable data that define which levels of exercise-induced changes in PAPm or PVR have prognostic implications, a disease entity ‘PH on exercise’ can not be defined and should not be used.