Elevated blood pressure in the lung artery system is a condition known as pulmonary hypertension (pulmonary, for lung and hypertension, for high blood pressure) (PH), which is an important non-communicable cardiopulmonary disease that causes heart failure, hospitalisation and shortened lifespan. In contrast to ‘hypertension’, which is primarily a disease of aging affecting non-lung arteries and already well-known to the global health community, PH is distinct in several important ways.
- First, the epidemiology and demographic profile of PH is unrelated to hypertension.
- Second, the diagnosis of PH cannot be accomplished using a regular blood pressure assessment, but instead requires ultrasonographic or other methods.
- Third, even minimal elevation in pulmonary artery pressure is associate with cardiac dysfunction and a substantial increase in adverse clinical events.
- Finally, as much as 70% of the lung circulation may be abnormal prior to the development PH symptoms.
Taken together, PH is emerging as a major problem based on the absence of specific symptoms, poor prognosis, and misconceptions about its diagnosis and the care of affected patients. It is truly a global problem, affecting populations in high, middle and low income countries.
Although it is well-established that common forms of lung, heart and blood disease increase the risk of developing PH, the overall global impact of PH has come into greater focus more recently. It is now estimated, for example, that nearly 70 million people have PH across the world, with a projected prevalence of 10% among individuals >65 years of age, spanning populations in industrialised and developing countries.
Although an important cause of PH is due to infections, such as Schistosomiasis mansoni and the human immunodeficiency virus, non-infectious forms of PH are common and recognised increasingly in the context of global threats to health, such as malnutrition and pollution, among others. Indeed, it is anticipated that the World Health Organization will recognise for the first time PH among the top 10 most common and burdensome non-communicable diseases worldwide. Yet, PH is overlooked and misdiagnosed often even in the United Kingdom, Europe Union, United States, Australia and other geographic regions that have focused on PH clinically and academically for more than 30 years.
The Pulmonary Vascular Research Institute (PVRI) is a global medical society committed to advancing all aspects of PH, from molecular sciences emphasising drug discovery to comprehensive educational programmes for the public and practitioners. We are an integrated network of scientists, clinicians, public health officers, and patient advocates representing 103 countries and all inhabited continents.
The PVRI mission diverges from other associations by virtue of our focus on the global impact of PH. We view PH as a silent killer on an international scale, which can no longer be ignored.
World PH Day on May 5 is an opportunity to reinforce our commitment to optimising diagnosis, treatment, and outcome of this highly morbid disease. Moreover it is vital that we improve the access to effective therapies for patients residing in low income countries, who are currently denied such opportunity. In this light, we look forward to strengthening our collaboration with NCDA to amplify PH awareness, including that PH is a preventable and treatable condition.
Suggested further readings
- Hoeper MM, and colleagues. A global view of pulmonary hypertension. Lancet Respir Med 2016; 4: 306-322.
- Sofianopoulou E, and colleagues. Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis.Eur Respir J. 2019 May 30;53(5).
Dr Bradley A. Maron, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA USA
Professor Paul Corris, Emeritus Professor of Thoracic Medicine Newcastle University Newcastle Upon Tyne UK. Chairman of Board Pulmonary Vascular Research Institute.