Untangling severe pulmonary hypertension in chronic obstructive pulmonary disease

Pulmonary hypertension (PH) is a pathophysiological disorder characterized by an abnormal increase in pulmonary arterial pressure (PAP) that may be due to or associated with a variety of clinical conditions. 1 Humbert M. Kovacs G. Hoeper M.M. et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022; 43: 3618-3731https://doi.org/10.1093/eurheartj/ ehac237 Crossref PubMed Scopus (0) Google Scholar Pulmonary hypertension is a major health problem with an estimated prevalence of 1% of the global population, mainly because it is a frequent complication of prevalent chronic heart or lung diseases. 2 Hoeper M.M. Humbert M. Souza R. et al. A global view of pulmonary hypertension. Lancet Respir Med. 2016; 4: 306-322https://doi.org/10.1016/S2213-2600(15)00543-3 Abstract Full Text Full Text PDF PubMed Scopus (495) Google Scholar Pulmonary hypertension is common in patients with chronic obstructive pulmonary disease (COPD). A recent meta-analysis showed a prevalence of PH of 39% across the whole COPD spectrum, with a higher prevalence in patients with very severe disease. 3 Zhang L. Liu Y. Zhao S. et al. The Incidence and Prevalence of Pulmonary Hypertension in the COPD Population: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis. 2022; 17: 1365-1379https://doi.org/10.2147/COPD.S359873 Crossref PubMed Scopus (10) Google Scholar The presence of PH in COPD is associated with a higher risk of mortality, 4 Hurdman J. Condliffe R. Elliot C.A. et al. Pulmonary hypertension in COPD: results from the ASPIRE registry. European Respiratory Journal. 2013; 41: 1292-1301https://doi.org/10.1183/09031936.00079512 Crossref PubMed Scopus (166) Google Scholar more frequent exacerbations 5 Klinger J.R. Wu B. Morland K. et al. Burden of pulmonary hypertension due to chronic obstructive pulmonary disease: Analysis of exacerbations and healthcare resource utilization in the United States. Respir Med. 2023; 219https://doi.org/10.1016/j.rmed.2023.107412 Abstract Full Text Full Text PDF Scopus (0) Google Scholar and lower exercise tolerance. 6 Torres-Castro R. Gimeno-Santos E. Vilaró J. et al. Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis. Eur Respir Rev. 2021; 30200321https://doi.org/10.1183/16000617.0321-2020 Crossref Scopus (19) Google Scholar