Global distribution of prognostically significant pulmonary pressure indicative of pulmonary hypertension

There remains a paucity of data to describe how many people worldwide are affected by pulmonary hypertension (PH), an insidious condition associated with adverse vascular remodelling, progressive heart failure, and death without proactive diagnosis and management.

We combined data on the population rate of echocardiographic investigations with tricuspid regurgitant velocity (TRV) levels observed within a clinical cohort of >500 000 people, to conservatively estimate the number of adults with mild (TRV 2.5-2.8 m/s), moderate (TRV 2.9-3.4 m/s) and severe (>3.4 m/s) PH in Australia. We then applied the estimated number of PH cases (age- and sex-specific) to World Bank population estimates for 2021.

We conservatively estimate that 16.01 (95% confidence interval (CI) = 15.31-16.71) million men and 15.53 (95% CI = 14.79-16.27) million women, representing 0.616% (95% CI = 0.589-0.643%) and 0.589% (95% CI = 0.561-0.617%) of those aged 20-79 years worldwide, are affected by mild to severe forms of PH. The highest to lowest proportion of cases occur in Southern/Western Europe ( ~ 0.84% men and ~ 0.76% women) and sub-Saharan Africa ( ~ 0.40% both sexes), respectively. In absolute terms, the greatest number of PH cases reside in Eastern ( ~ 9.0 million) and Southern ( ~ 6.5 million) Asia. PH associated with left heart disease is predominant globally, with an estimated 8.7 (0.33%) and 7.5 (0.28%) million male and female cases worldwide. However, in sub-Saharan Africa, those aged <45 years and without left heart disease account for 11.7% of all PH cases compared to <4.0% of cases in Europe/North America.

For the first-time, we provide conservative estimates of the global pattern of PH (affecting ~ 31.5 million people). These findings provide a rationale for more definitive burden-of-disease studies focusing on likely regional differences in causality and how PH might be successfully prevented/treated.