[Innovations in targeted therapies for pulmonary hypertension: advancing from vasodilation to vascular remodeling]

Pulmonary hypertension (PH) is a heterogeneous disease driven by multiple pathological mechanisms. Its core characteristics include pulmonary vascular constriction and pulmonary vascular remodeling. Currently, the clinical treatment of PH primarily relies on vasodilatory drugs, including endothelin pathway antagonists, prostacyclin analogues, and regulators of the NO-sGC-cGMP pathway. Although these drugs can alleviate symptoms and improve hemodynamics to a certain extent, they are unable to fundamentally reverse pulmonary vascular remodeling and have limitations in improving the long-term prognosis of the disease. Therefore, developing drugs that can directly intervene and reverse pulmonary vascular structural abnormalities has become a new direction for treatment. Numerous studies, both at home and abroad, have demonstrated that targeted therapy has significant value in improving the prognosis of patients with PH. This article will discuss three aspects: the innovation of classic pathways, new drugs targeting remodeling, and cutting-edge translational research in metabolism and immunity, aiming to clarify the transformation of current treatment strategies from "vasodilation" to "inhibiting vascular remodeling".