Authors: Pugh ME et al., Chest 2014 Jul 146:159
Left heart disease was a more likely cause of pulmonary hypertension in an older population.
Pulmonary hypertension is being diagnosed in a growing number of older adults, but whether this trend is due to pulmonary arterial hypertension (PAH; pulmonary hypertension not secondary to left heart disease or intrinsic lung disease) or alternate causes is unknown. Because therapies for PAH are unique, determining the etiology of pulmonary hypertension is important.
Investigators at Vanderbilt University examined 246 older patients (age, greater than 65) who were referred for initial evaluation of pulmonary hypertension during 15 years. Most patients were women (78%), and mean age was 73. Left heart disease (WHO group 2) was the most common cause of pulmonary hypertension (28%), with most such patients having preserved systolic function. PAH was diagnosed in only 36 patients (14%), and three quarters of these cases were associated with connective tissue disease. In 17% of cases, multiple etiologies contributed to pulmonary hypertension.
This study demonstrates that older patients can present with PAH, but PAH is quite rare in this group. This finding emphasizes the need for thorough evaluation before initiation of PAH-specific treatments in older patients in whom elevated systolic pulmonary artery pressures are detected.