Normal Pulmonary Artery Pressure

The normal mean pulmonary arterial pressure at rest is 14 ± 3 mmHg with an upper limit of normal of approximately 20 mmHg. 1

Mean Pulmonary Arterial Pressure (mPAP)

Normal mPAP at rest is 14 ± 3 mmHg 1
The upper limit of normal for mPAP is approximately 20 mmHg 1
mPAP between 21-24 mmHg is of uncertain clinical significance but warrants close follow-up, especially in patients at risk for developing pulmonary arterial hypertension 1
Pulmonary hypertension is defined as mPAP ≥ 25 mmHg at rest as measured by right heart catheterization 1
Recent guidelines have updated the threshold for pulmonary hypertension to mPAP > 20 mmHg based on the upper limit of normal pulmonary artery pressure in healthy individuals 1

In healthy individuals, the average pulmonary artery systolic pressure measured by right heart catheterization is approximately 21 ± 4 mmHg 1
The upper limit of normal PASP is around 30 mmHg 1, 2
On echocardiography, estimated PASP (ePASP) > 30 mmHg is generally outside the normal range in most healthy individuals 1
Normal right ventricular systolic pressure (RVSP) is less than 35 mmHg, with an upper limit of normal considered to be 30-35 mmHg in adults 2

Resting mPAP is slightly influenced by age 3:
- <30 years: 12.8 ± 3.1 mmHg 3
- 30-50 years: 12.9 ± 3.0 mmHg 3
- ≥50 years: 14.7 ± 4.0 mmHg 3
PASP increases with age, similar to systemic blood pressure 1
In elderly individuals (≥50 years), PASP values may be higher than in younger individuals, even during mild exercise 3

Body position slightly influences resting mPAP 3:
- Supine position: 14.0 ± 3.3 mmHg 3
- Upright position: 13.6 ± 3.1 mmHg 3

Normal mPAP during exercise is dependent on exercise level and age 3
During mild exercise, mPAP averages 19.4 ± 4.8 mmHg in subjects aged <50 years compared with 29.4 ± 8.4 mmHg in subjects ≥50 years 3
The term "pulmonary hypertension on exercise" is no longer used due to lack of reliable data defining which levels of exercise-induced changes in mPAP have prognostic implications 1
Approximately 50% of healthy subjects >50 years old exhibit mPAP >30 mmHg during mild exercise 4

Even mild elevations in pulmonary artery pressure (mPAP 20-24 mmHg) are associated with increased mortality 1
ePASP >30 mmHg on echocardiography is present in over 40% of clinical echocardiograms and is associated with a five-year mortality of 25-40% 1
The mortality risk rises by about 40% with every 10 mmHg increase in PA systolic pressure 1

Right heart catheterization remains the gold standard for measuring pulmonary artery pressures 4
PASP can be estimated non-invasively using echocardiography by measuring the velocity of the tricuspid regurgitation jet 1
RVSP is calculated using the modified Bernoulli equation: RVSP = 4v² + RAP, where v is the peak velocity of the tricuspid regurgitation jet and RAP is the estimated right atrial pressure 2
Absence of a measurable tricuspid regurgitation jet does not rule out elevated pulmonary artery pressure 1