Pulmonary hypertension in 2012: contemporary issues in diagnosis and management

Pulmonary hypertension (PH) is a hemodynamic state of the pulmonary circulation characterised by an elevated pulmonary artery pressure. It can be the consequence of a wide variety of etiologies requiring distinct therapeutic approaches. Enormous progress has been made over the past decade in this field. A better understanding of the molecular basis of pulmonary vascular remodelling has led to development of therapies that target the specific dysfunctional pathways implicated in disease pathogenesis. Multiple classes of pulmonary specific vasodilator agents are now available for the treatment of the subgroup with pulmonary arterial hypertension (PAH), although the optimal therapeutic approach (such as combination therapy) is still evolving. With effective therapy, early detection of PAH in high-risk populations has become an important objective. The use of specific vasodilator therapy for PH secondary to left-sided heart disease or chronic lung disease is currently not supported by robust evidence. This review will summarise some of the recent advances in the field including disease classification, disease detection, and the contemporary approach to therapy.