Gaps in evidence in the management of patients with intermediate-risk pulmonary arterial hypertension: Considerations following the ESC/ERS 2022 guidelines

Vascul Pharmacol. 2024 Jun:155:107374. doi: 10.1016/j.vph.2024.107374. Epub 2024 Apr 18.

Abstract

A comprehensive evaluation of risk, using multiple indices, is necessary to provide reliable prognostic information and guide therapy in pulmonary arterial hypertension (PAH). The current ESC/ERS guidelines suggest using a three-strata model for incident (newly diagnosed) patients and a four-strata model for prevalent patients with PAH. The four-strata model serves as a fundamental risk-stratification tool and relies on a minimal dataset of indicators that must be considered during follow-up. Nevertheless, there are still areas of vagueness and ambiguity when classifying and managing patients in the intermediate-risk category. For these patients, considerations should include right heart imaging, hemodynamics, as well as individual factors such as age, sex, genetic profile, disease type, comorbidities, and kidney function. The aim of this report is to present case studies, with a specific focus on patients ultimately classified as intermediate risk. We aim to emphasize the challenges and complexities encountered in the realms of diagnosis, classification, and treatment for these particular patients.

Keywords: Guidelines; Pulmonary arterial hypertension; Risk stratification; Therapy.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents* / therapeutic use
  • Arterial Pressure / drug effects
  • Clinical Decision-Making
  • Decision Support Techniques
  • Evidence-Based Medicine / standards
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Predictive Value of Tests
  • Pulmonary Arterial Hypertension* / diagnosis
  • Pulmonary Arterial Hypertension* / epidemiology
  • Pulmonary Arterial Hypertension* / physiopathology
  • Pulmonary Arterial Hypertension* / therapy
  • Pulmonary Artery / physiopathology
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome

Substances

  • Antihypertensive Agents