Pulmonary hypertension: modern approaches to diagnosis and treatment

Abstract

This review offers a contemporary analysis of the evolving landscape of pulmonary hypertension (PH) diagnosis and management. It synthesizes current evidence on disease mechanisms and therapeutic approaches, with particular emphasis on the pivotal changes introduced by the 2022 ESC/ERS guidelines. Central to this update is the revised hemodynamic definition of PH, now confirmed at a mean pulmonary arterial pressure >20 mm Hg at rest, and a stricter criterion for pulmonary arterial hypertension (PAH) requiring a pulmonary vascular resistance >2 Wood Units. The article navigates the refined diagnostic algorithm essential for accurately distinguishing between the five clinical PH groups. Furthermore, it elaborates on the modern, multi-parameter risk stratification strategy, a critical tool for prognostication and tailoring treatment intensity. The efficacy of established targeted drug classes–including endothelin receptor antagonists, phosphodiesterase-5 inhibitors, soluble guanylate cyclase stimulators, and prostacyclin pathway agents–is evaluated. The rationale for employing combination therapy and the indications for invasive procedures such as atrial septostomy and lung transplantation are also discussed. While a cure remains elusive, the systematic adoption of a personalized, risk-based treatment paradigm is demonstrated to markedly enhance functional capacity, quality of life, and long-term survival outcomes for patients.