Whenever you go to the doctor, one of the first things they likely check is your blood pressure. They want to make sure you don’t have hypertension, a serious condition where the pressure in our arteries is higher than it should be.
However, with pulmonary hypertension (PH), the blood vessels in the lungs are affected. The increased pressure can damage the blood vessels and make it difficult for the heart to pump blood to the lungs. In observance of Pulmonary Hypertension Awareness Month, we talked to Brian Wu, M.D., pediatric pulmonologist and HMSA senior medical director, to understand the different types of pulmonary hypertension, risk factors, symptoms, and treatments.
Q&A with Brian Wu, M.D.
What is PH?
It means there’s high pressure in the blood vessels in the lungs. This isn’t the same as what most people call high blood pressure, which is when the pressure in the blood vessels that go to the rest of your body is high.
Think of your heart like a pump and your blood vessels like pipes. Your body needs oxygen. Blood carries that oxygen throughout the body. After your body uses up the oxygen from the blood, the blood goes to the right side of your heart. Then, your heart pumps this blood into your lungs through special blood vessels called pulmonary arteries, where the blood picks up more oxygen. The fresh, oxygen-rich blood moves to the left side of your heart, which sends it out to the rest of your body.
If the pressure in the pulmonary arteries gets too high (aka pulmonary hypertension), the right side of your heart has to work much harder to push blood into your lungs. This can cause the right side of the heart to weaken or fail, and then your body doesn’t get enough oxygen.
What are the different types of PH?
World experts agree on five groups of adult PH based on their cause:
- Group 1: Pulmonary arterial hypertension. This group is caused when the arteries in the lungs become narrowed, thickened, or stiff.
- Group 2: Pulmonary hypertension associated with left heart disease. Most common type of PH.
- Group 3: Pulmonary hypertension associated with lung diseases and/or hypoxia (low oxygen level). The most common example is chronic obstructive pulmonary disease or COPD (a progressive lung disease that makes it difficult to breathe), but there are other diseases that can cause PH such as emphysema (a type of COPD that affects the air sacs in the lungs and untreated obstructive sleep apnea (a sleep-related breathing disorder).
- Group 4: Pulmonary hypertension with pulmonary artery obstruction. This is caused by chronic blood clots in the lungs.
- Group 5: Pulmonary hypertension with unclear and/or multifactorial mechanisms.
Examples include blood disorders, metabolic disorders, systemic disorders, chronic kidney failure, and complex congenital heart disease.
In children, the grouping is similar to that in adults, but experts have used additional classifications due to conditions unique to children.
Why is PH a concern?
It’s serious and potentially life-threatening because it progressively strains the right side of the heart, reducing its ability to pump blood effectively. This leads to an inability to get enough oxygen, which can result in heart failure and can impact many other organs in the body due to poor blood flow. It often goes unrecognized until it’s advanced or severe and can have a high mortality rate.
Who’s at risk for PH?
In addition to those who have some of the example conditions I mentioned above, preventable lifestyle risk factors include smoking history and physical inactivity.
What are some common symptoms of PH?
The symptoms of PH are nonspecific and progress as the disease advances. If you develop any of these symptoms that can be associated with PH, you should contact your health care provider:
- Shortness of breath (especially with exertion)
- Fatigue (limiting daily activity)
- Frequent chest pain or discomfort
- Dizziness or fainting (typically with exertion)
- Swelling in ankles/legs (edema)
- Sensation of rapid or irregular heartbeat
Since there’s no cure for PH, what are some ways to treat it?
PH due to chronic blood clots is sometimes curable, primarily through surgery. Otherwise, treatment focuses on slowing progression or improving (but not permanently “curing”) PH. Treatment options depend on the cause.
For example, those with group 1 (pulmonary arterial hypertension) may be candidates for targeted drug therapies typically prescribed by health professionals who manage this condition.
For those with group 2 (left heart disease), group 3 (lung disease), and group 5 (multifactorial), focus on treating the underlying condition(s) is key.
Those with low oxygen should receive oxygen therapy to improve symptoms; low oxygen levels can worsen pulmonary hypertension.
Lifestyle changes may include structured exercise and health care professional-recommended modified diets.
If the PH is very advanced, a lung transplant may be suggested for some. However, a lung transplant isn’t a cure and carries a high risk of complications itself.
Anything else you’d like to share during Pulmonary Hypertension Awareness Month?
Early detection matters! PH often goes undiagnosed until advanced stages. Because the different kinds of pulmonary hypertension are treated differently, your health care provider may consider referring you to centers specializing in PH.
Research is ongoing, and the good news is that new therapies and better diagnostic tools are emerging. Raising awareness helps reduce delays in diagnosis and treatment. Here are some additional general education materials on PH:
- About Pulmonary Hypertension (Pulmonary Hypertension Association)
- What is Pulmonary Hypertension (American Thoracic Society Patient Education)
- Pulmonary Hypertension (American Heart Association)
You don’t have to wait for a specific day, week, or month to learn about various health conditions,you can check out these articles:
- anxiety awareness month
- cataract awareness month
- celiac disease awareness month
- check yourself during cholesterol education awareness month
- children’s health month
- encourage healthy growth during childhood obesity month
- irritable bowel syndrome awareness month
- menopause awareness month
- national suicide prevention month (part I) and (part II)
- neonatal intensive care unit (nicu) awareness month
- post-traumatic stress disorder awareness month
- preeclampsia awareness month
- sarcoma awareness month
- thyroid awareness month
