Managing Pulmonary Arterial Hypertension With Cardiopulmonary Comorbidities.

Pulmonary arterial hypertension (PAH) and pulmonary hypertension associated with left-sided heart and lung diseases are most commonly easily discriminated and treated accordingly. With the changing epidemiology of PAH, however, a growing proportion of patients at the time of diagnosis present with comorbidities of varying severity. In addition to classical PAH, two distinct phenotypes have emerged: a heart failure with preserved ejection fraction-like phenotype and a lung phenotype. Importantly, the evidence supporting the currently proposed treatment algorithm for PAH has been generated mainly from PAH trials in which patients with cardiopulmonary comorbidities have been underrepresented or excluded. As a consequence, the best therapeutic approach for patients with common PAH with cardiopulmonary comorbidities remains largely unknown and requires further investigation. The present article reviews the relevant literature on the topic and describes the authors' views on the current therapeutic approach for these patients.
Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: S. P. reports grants from the Canadian Institutes for Health Research, Janssen, AstraZeneca, and Resverlogix, outside the submitted work; and speaker’s fees from Janssen. S. B. reports speaker’s fees from Janssen and Morphic; a Distinguished Research Scholar from the Fonds de Recherche du Quebec-Santé, and grants from the Canadian Institutes for Health Research, Janssen and Morphic. None declared (V. M.).
(Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)