Why there is a need to discuss pulmonary hypertension other than pulmonary arterial hypertension?

• 作者: Athanasios Papathanasiou George Nakos
• 来源期刊: 世界重症医学杂志
• 学科: 医学
• 关键词: PULMONARY HYPERTENSION PULMONARY ARTERIAL HYPERTENSION Chronic OBSTRUCTIVE PULMONARY disease Heart failure Treatment
• 年，卷（期）: 2015,（4）
• 页码范围: 274-277
• 页数: 4页
• 分类号: R

摘要

Pulmonary hypertension(PH)is a condition characterized by the elevation of the mean pulmonary artery pressure above 25 mmHg and the pulmonary vascular resistance above 3 wood units.Pulmonary arterial hypertension(PAH)is an uncommon condition with severe morbidity and mortality,needing early recognition and appropriate and specific treatment.PH is frequently associated with hypoxemia,mainly chronic obstructive pulmonary disease and DPLD and/or left heart diseases(LHD),mainly heart failure with reduced or preserved ejection fraction.Although in the majority of patients with PH the cause is not PAH,a significant number of published studies are still in regard to groupⅠPH,leading to a logical assumption that PH due to other causes is not such an important issue.So,is there a reason to discuss PH other than PAH?Chronic lung diseases,mainly chronic obstructive lung disease and DPLD,are associated with a high incidence of PH which is linked to exercise limitations and a worse prognosis.Although pathophysiological studies suggest that specific PAH therapy may benefit such patients,the results presented from small studies in regard to the safety and effectiveness of the specific PAH therapy are discouraging.PH is a common complication of left heart disease and is related to disease severity,especially in patients with reduced ejection fraction.There are two types of PH related to LHD based on diastolic pressure difference(DPD,defined as diastolic pulmonary artery pressure-mean PAWP):Isolated post-capillary PH,defined as PAWP>15 mmHg and DPD<7 mmHg,and combined post-capillary PH and pre-capillary PH,defined as PAWP>15 mmHg and DPD≥7 mmHg.The potential use of PAH therapies in patients with PH related to left heart disease is based on a logical pathobiological rationale.In patients with heart failure,endothelial dysfunction has been proposed as a cause of PH and hence as a target for treatment,supported by the presence of increased endothelin-1 activity and impaired nitric oxide-dependent vasodilation.Unfortunately,so fa