Pulmonary hypertension
Also known as: PAH · PH · pulmonary arterial hypertension
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Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST Guideline and Expert Panel Report
CHEST (American College of Chest Physicians) · 2019
CHEST's expert-panel guideline on pharmacologic therapy for pulmonary arterial hypertension in adults, the fourth iteration in the series and an update of the 2014 report.
2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension
ESC / ERS · 2022
The fourth joint ESC/ERS edition, covering the full spectrum of pulmonary hypertension with particular depth on pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.
US vs EU key differences
- Haemodynamic definition differs: the 2022 ESC/ERS guideline lowered pulmonary hypertension to mean PAP above 20 mm Hg and pre-capillary PH to PVR above 2 Wood units, whereas the 2019 CHEST document predates this and works from the older mPAP of at least 25 mm Hg with PVR of at least 3 Wood units. source
- The ESC/ERS guideline also reinstated exercise pulmonary hypertension, defined by an mPAP/cardiac output slope above 3 mm Hg/L/min between rest and exercise; the CHEST therapy update has no equivalent concept. source
- Risk stratification differs structurally: ESC/ERS uses a three-strata model at diagnosis and a simplified four-strata COMPERA 2.0 model at follow-up built on WHO functional class, 6-minute walk distance and NT-proBNP, while the CHEST update organises therapy mainly by WHO functional class without a comparable multiparametric table. source
- The CHEST update's combination-therapy recommendation is drug-specific and weak: initial ambrisentan plus tadalafil over monotherapy for treatment-naive WHO functional class II-III patients, based largely on AMBITION. source
- Scope differs: CHEST 2019 covers only drug therapy for pulmonary arterial hypertension in adults, while the ESC/ERS document spans the whole PH spectrum including diagnosis, screening and chronic thromboembolic PH. source
What changed recently
- EU2015 → 20222022-08-26
The 2022 guidelines lower the haemodynamic definition of pulmonary hypertension from a mean pulmonary artery pressure of at least 25 mmHg to above 20 mmHg, and add a pulmonary vascular resistance threshold above 2 Wood units to define pre-capillary disease. Risk assessment moves from the 2015 three-strata model to a four-strata approach at follow-up, and PAH with venous/capillary involvement (PVOD/PCH) and persistent pulmonary hypertension of the newborn are folded into group 1.
source ↗curation confidence 90% - US2014 → 20192019-03-01
The 2019 CHEST update adds a weak recommendation for initial combination therapy with ambrisentan plus tadalafil in treatment-naive WHO functional class II-III patients to improve six-minute walk distance, and introduces consensus statements on integrating palliative care and supervised exercise training into PAH management. A visual treatment algorithm was added to make the 78 recommendations easier to apply at the bedside.
source ↗curation confidence 90%
See the full update feed for changes across every system.