Pulmonary Hypertension, (high blood pressure in the arteries to your lungs)

Hi Dr T, I had an echo in April of 2010 with an rvsp of 47. I underwent pulmonary function testing, antibody testing for scleroderma, arterial gas, chest xray etc. No cause could be found. In three months the echo was repeated with a rise in rvsp to 50. In jan of this year the rvsp was 57-60. I then underwent sleep apnea test and have been on cpap for three months. The latest echo done last week shows no change in the Jan echo with pressure still remaining 57-60. It was a limited echo and I will list the results. My cardiologist feels the cpap will lower it more over time along with weight loss as no other causes seem to be found. He wants to repeat in 3 months. Do you agree with this course of treatment or is there something more you would suggest? How long does it usually take cpap to make a difference in rvsp numbers? Here is the report: normal chamber dimensions; normal aortic root size normal left ventricular contractility and wall motion   estimated EF=65-70% normal valve morphology mild tricuspid regurgitation; moderate PH (right ventricular systolic pressure=60mmHg No pericardial effusion.

A lot goes into examining a patient for a long list of risks and causes of Pulmonary Hypertension (PH), and thus for its treatment. Pulmonary Hypertension is often diagnosed when your doctor finds an elevated blood pressure in your lungs , as part of an examination of chronic obstructive pulmonary disease (chronic bronchitis and emphysema), blood clots in the lung, or forms of congenital heart disease.

CPAP is indeed sometimes used very effectively in patients with sleep apnea, but the effect on co-existing Pulmonary Hypertension is less certain, unless there is evidence of congestive heart failure, which you don't have. PH has been described as one of the complications of obesity. Therefore, if you have a weight problem, losing with diet & exercise is a good idea. The ECHO of your heart shows that its function is well preserved and your heart valves work normally. Effective treatment of PH aims at keeping it that way, as well as protecting your lungs.

I have blogged about causes, risks, diagnosis and treatment of PH a number of times:



Primary pulmonary hypertension can be a severely debilitating disease. For treatment, patients should be encouraged to avoid circumstances such as high altitudes.  Patients with cardiopulmonary disease should be treated with oxygen for low oxygen levels, and cigarette smoking should be avoided.  Drugs that have vasoconstrictive actions should also be avoided.  So should barbiturates and other drugs that depress the heart function.  Blood thinners may be given to patients to help reduce the risk of blood clotting, and enable the blood to travel through the lung circulation better. Vasodilator therapy has been used for many years and heart-lung transplant remains as the ultimate therapy for patients who do not respond other treatments.

Hope this helps,
Dr T

(Picture from: Diagnosing Pulmonary Hypertension)


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