Hipertensiunea pulmonară – consideraţii generale.

Pulmonary hypertension (PH) defines an increase in mean pulmonary arterial pressure (PAPm) at a value equal to or greater than 25 mmHg, determined invasively by right cardiac catheterization. The hemodynamic definition of PH considers the combination of different hemodynamic parameters: mPAP, pulmonary wedge pressure (PWP), cardiac output (CO), diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR). The clinical correspondence of the haemodynamic definition, considering both the pathological aspect and the therapeutic approach, classifies the clinical conditions that associate PH in five clinical groups. Worldwide data on the incidence of pulmonary hypertension are not systematically reported; data on PH prevalence in different aetiologies are not published in detail. PH epidemiology documentation becomes necessary in order to standardize diagnostic and therapeutic management practices, with particular interest in aligning the differences between different regions of the world, not only geographically but also economically. The only data on the survival rate of PH patients in Eastern Europe are published from the Czech Republic registry. The better survival in the thromboembolic PH subgroup may be positively influenced by the availability of specific pharmacological therapy since 2007. The Portuguese registry reported in 2017 a survival rate at 1, 3 or 5 years of 95%, 77% and 71%, respectively, for new cases with different PH aetiologies, and the absence of statistically significant differences between different aetiology groups, but with a better prognosis for congenital heart disease related PH cases. For Romania, the National Pulmonary Hypertension Register has centralized the data from the six national diagnostic and treatment centres by 2017. The PH pathophysiology is based on pulmonary vascular remodelling by endothelial cell proliferation, smooth muscle cell hypertrophy and perivascular inflammation. [ABSTRACT FROM AUTHOR]