Normal Peak Pulmonary Pressure
Normal mean pulmonary artery pressure at rest is 14 ± 3 mmHg, with an upper limit of normal of approximately 20 mmHg, while normal pulmonary artery systolic pressure (peak pressure) averages 21 ± 4 mmHg with an upper limit around 30 mmHg. 1, 2
Mean Pulmonary Artery Pressure (mPAP)
The normal resting mean pulmonary artery pressure is 14 ± 3 mmHg based on comprehensive international data from healthy individuals 1, 2
The upper limit of normal is 20 mmHg at rest, which represents a critical threshold for defining abnormal pulmonary pressures 1, 3, 2
Pressures between 21-24 mmHg represent a gray zone with uncertain clinical significance, though these mild elevations are associated with increased mortality and warrant further evaluation 1, 3, 2
Pulmonary Artery Systolic Pressure (PASP - "Peak" Pressure)
In healthy individuals measured by right heart catheterization, the average pulmonary artery systolic pressure is approximately 21 ± 4 mmHg 2
The upper limit of normal for PASP is around 30 mmHg 2
On echocardiography, an estimated PASP >30 mmHg is generally outside the normal range in most healthy individuals 2
Clinical Context and Measurement Considerations
Right heart catheterization is the gold standard for measuring pulmonary pressures and is required to confirm any diagnosis of pulmonary hypertension 3, 4
Echocardiography can estimate PASP non-invasively by measuring the tricuspid regurgitant jet velocity using the modified Bernoulli equation, but this is not sufficient to support treatment decisions when considering specific therapy for pulmonary hypertension 3, 4
Even mild elevations in pulmonary pressure (mPAP 20-24 mmHg) are associated with increased mortality, emphasizing the clinical importance of values near the upper limit of normal 3, 2
On echocardiography, estimated PASP >30 mmHg is present in over 40% of clinical echocardiograms and carries a 5-year mortality of 25-40%, with mortality risk rising approximately 40% with every 10 mmHg increase 2
Definition of Pulmonary Hypertension
Pulmonary hypertension is defined as mean PAP ≥25 mmHg at rest by traditional criteria used in clinical trials, though recent guidelines suggest >20 mmHg as the threshold based on the upper limit of normal 1, 3