From the Guidelines
A right ventricular systolic pressure (RVSP) of 72 mmHg is considered severe pulmonary hypertension. Pulmonary hypertension is typically classified as mild (RVSP 35-45 mmHg), moderate (RVSP 45-60 mmHg), and severe (RVSP >60 mmHg) 1. At 72 mmHg, this value significantly exceeds the threshold for severe pulmonary hypertension and indicates substantial pressure elevation in the pulmonary circulation. This high pressure puts strain on the right ventricle, which must work harder to pump blood through the lungs.
Key Considerations
- Patients with this level of pulmonary hypertension typically require prompt evaluation by a pulmonary hypertension specialist and aggressive treatment, which may include vasodilator medications such as phosphodiesterase-5 inhibitors (sildenafil, tadalafil), endothelin receptor antagonists (bosentan, ambrisentan), prostacyclin analogs (epoprostenol, treprostinil), or combination therapy depending on the underlying cause 1.
- The severity of pulmonary hypertension correlates with increased morbidity and mortality, making timely diagnosis and management crucial for improving outcomes and preventing right heart failure.
- According to the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline, severe PH is defined according to hemodynamics and additional data derived from clinical assessment, exercise tests, and laboratory biomarkers, with a mean pulmonary artery pressure >40 mm Hg, pulmonary vascular resistance >5 Wood units, or echocardiographic evidence of significant RV dysfunction 1.
Treatment and Management
- Treatment options may include short-acting inhaled pulmonary vasodilators, such as nitric oxide or aerosolized prostacyclins, to reduce elevated RV afterload and prevent acute decompensated right heart failure 1.
- Patients with severe pulmonary hypertension should be managed and followed at a center with PH specialists, as they are at high risk for developing severe PH if left untreated 1.
From the Research
Classification of Pulmonary Hypertension
To determine whether a RVSP of 72 mmHg is considered moderate or severe pulmonary hypertension, we need to look at the classification criteria used in medical studies.
- According to the study 2, RVSP is categorized as follows:
- Normal: < 40 mm Hg
- Severely elevated: ≥ 60 mm Hg
- Moderately elevated: 50-59 mm Hg
- Mildly elevated: 40-49 mm Hg Given that the RVSP of 72 mmHg exceeds the threshold for severe elevation, it falls into the category of severe pulmonary hypertension.
Definition and Diagnosis of Pulmonary Hypertension
Pulmonary hypertension is defined by an increase in pulmonary arterial pressure, which can be due to various causes, including cardiopulmonary conditions or systemic diseases 3, 4.
- The diagnosis and management of pulmonary arterial hypertension involve assessing the severity of the condition and implementing disease-specific therapies 4.
- Studies have also explored the effects of certain medications, such as sildenafil, on pulmonary hypertension, particularly in the context of mitral valve replacement surgery 5.
Severity Assessment
The severity of pulmonary hypertension can be assessed through various hemodynamic measurements, including RVSP, mean pulmonary artery pressure, and pulmonary vascular resistance index 5.