Treating pulmonary hypertension in the elderly

Despite an increasingly older pulmonary hypertension (PH) population, data on PH treatments in these patients are limited because there exist no clinical studies dedicated to geriatric groups. Furthermore, elderly patients with comorbidities have been systematically excluded from clinical trials, limiting the evidence base for drugs approved for pulmonary arterial hypertension (PAH).

This review is focused on the diagnosis and treatment of pulmonary hypertension (PH) in the elderly, which is a hot topic today. Areas covered by the authors include current changes in demographics, clinical characteristics, diagnoses, and risk assessment in the geriatric PAH population. A central part of this review is dedicated to the therapeutic challenges in elderly patients with PAH. The literature search is focused on sorting out post-capillary conditions in the elderly, and on current treatment strategies for PAH and for chronic thromboembolic pulmonary hypertension (CTEPH).

Current data indicate that despite more severe disease in elderly patients, the concept of hit hard and early is less used. For example, double upfront oral combination, a common strategy for younger patients, or early parenteral prostacyclins, are less used in the elderly, purporting worse outcomes for these patients.