The year since the guidelines: a concise update on recent advances in pulmonary hypertension

Since the updated pulmonary hypertension (PH) guidelines published in 2015, two major landmark trials have provided additional insight regarding therapeutic algorithms of PH. In this review, we concisely summarized the key findings of peer‑reviewed studies published in the last one year in the field of PH. These studies have enhanced our therapeutic abilities by introducing a new potent agent, selexipag, and by demonstrating the advantage of upfront combination therapy (endothelin receptor antagonist and phosphodiesterase‑5 inhibitor) versus single agent therapy in group 1 PH. The addition of these therapeutic options resulted in mild improvement in certain clinical endpoints. Disappointingly, the improvement in clinical and hemodynamic endpoints was modest, not "across the board" and did not result in a measurable mortality reduction. Similarly, the role of agents traditionally used predominantly for primary PH or PH associated with connective tissues disease were tested in subjects with predominantly left heart failure. The progress in diagnostic modalities and strategies such as evaluation and validation of newer biomarkers, impact of borderline elevated pulmonary pressure and the role of various imaging modalities is briefly discussed but these investigations bears no groundbreaking amendments in current diagnostic algorithms.