Recognition and management of pulmonary hypertension

Pulmonary hypertension is a common manifestation of many diverse diseases. In most cases, the cause of elevated pulmonary arterial pressure is apparent on the basis of history, physical examination, chest x-ray, and ancillary noninvasive tests such as blood gases, pulmonary function tests, or echocardiography. Occasionally, more invasive tests such as cardiac catheterization and pulmonary angiography may be necessary. In those patients in whom no cause can be found, the pulmonary hypertension is labeled as primary or idiopathic. Effective therapy exists for alleviating pulmonary hypertension in most cases of secondary pulmonary hypertension. The prognosis of patients with primary pulmonary hypertension is dismal, although encouraging reports are beginning to appear regarding the use of vasodilators.