Pulmonary Hypertension, Explained
Pulmonary hypertension is a condition in which blood pressure in the arteries that lead from the heart to the lungs becomes too high. Over time, the increased pressure can strain the right ventricle — the chamber of the heart that pumps blood that is low in oxygen to the lungs — potentially increasing an individual’s risk for heart failure.
Though certain forms of pulmonary hypertension do not have a cure, there are effective treatment options that can ease symptoms and help improve your quality of life. Here’s what to know about recognizing and treating pulmonary hypertension.
What is pulmonary hypertension?
To understand pulmonary hypertension, it’s helpful to know how blood naturally flows from the heart to the lungs. The right ventricle — the heart’s lower right chamber — pumps blood without oxygen to the lungs through a large blood vessel called the pulmonary artery. After entering the lungs, the blood releases carbon dioxide and acquires oxygen. It then flows through pulmonary arteries to the left side of the heart.
Pulmonary hypertension occurs when the pulmonary arteries become narrowed, obstructing the flow of blood. This causes blood pressure in the pulmonary arteries to rise, which strains the heart’s right ventricle. In the long term, the right ventricle gradually grows weaker and becomes less effective at pumping blood to the lungs. In some cases, this may lead to the development of heart failure.
Pulmonary hypertension is a progressive condition. Symptoms become more severe over time without effective treatment, and getting a diagnosis at an early stage is critical.
Pulmonary hypertension causes and risk factors
There are different types of pulmonary hypertension. While not all cases of pulmonary hypertension have a known cause, it frequently intersects with other health conditions.
The inflammation and loss of capillaries caused by advanced chronic obstructive pulmonary disease (COPD) may increase pulmonary artery pressure, resulting in pulmonary hypertension. For individuals living with both conditions, COPD flare-ups can worsen symptoms of pulmonary hypertension. Other lung conditions including pulmonary fibrosis have been linked to pulmonary hypertension.
Pulmonary hypertension often occurs in connection with certain types of heart disease including aortic valve disease, left heart failure, mitral valve disease, and congenital heart disease.
The following health conditions have also been linked to the development of pulmonary hypertension.
- Liver disease can cause high blood pressure in the veins leading to the liver, also referred to as portal hypertension. This condition may expose blood vessels in the lungs to toxic substances, potentially damaging the small arteries of the lungs and leading to a form of pulmonary hypertension known as pulmonary arterial hypertension.
- Rheumatic disorders such as scleroderma and lupus
- Thromboembolic disease, a condition characterized by a blood clot in a large pulmonary artery
- Obesity and sleep apnea
Some cases of pulmonary hypertension may have a genetic component. For those who have a family health history of pulmonary hypertension, it’s even more imperative to seek early evaluation for a diagnosis if symptoms appear.
Pulmonary hypertension affects individuals of all ages and sexes, but it is significantly more common in young adults, and approximately twice as common in women as in men.
Symptoms of pulmonary hypertension
Symptoms of pulmonary hypertension often do not appear until the condition has progressed to a later stage. For many individuals, the first symptom is shortness of breath during daily activities. Other common symptoms include fatigue, dizziness, fainting spells, swelling in the ankles, abdomen, or legs, and chest pain.
As the condition progresses further, it becomes increasingly difficult to carry out daily activities, and you may experience difficulty breathing even while at rest.
Potential health complications
Pulmonary hypertension is linked to the following health conditions or complications.
- Right-sided heart enlargement and heart failure, as pulmonary hypertension causes the heart to pump harder than normal to carry blood through narrowed arteries
- Increased risk for blood clots in the small arteries in the lungs
- Irregular heartbeats, or arrhythmias
- Bleeding in the lungs
Treatment and prevention of pulmonary hypertension
Treatment for pulmonary hypertension often consists of a combination of medications, oxygen therapy, and lifestyle changes.
The following medications may be used in the treatment of pulmonary hypertension.
- Anticoagulants, or blood thinners, like warfarin allow blood to flow more freely through the arteries by decreasing blood clot formation.
- Diuretics including furosemide (Lasix®), torsemide (Demadex®), and spironolactone (Aldactone®) reduce swelling and make it easier to breathe by removing excess fluid from the bloodstream.
- Inotropic agents like digoxin can improve the heart's pumping ability.
- Vasodilators including nifedipine (Procardia®), diltiazem (Cardizem®), epoprostenol (Flolan®, Veletri®), and treprostinil (Tyvaso®, Remodulin®, Orenitram®) lower pulmonary blood pressure and can help improve the heart’s ability to pump blood.
- Soluble guanylate cyclase (sCG) stimulators such as riociguat (Adempas®) help your body release more nitric acid to relax vascular smooth muscle and increase the amount of blood your heart can pump.
- Endothelin receptor antagonists such as bosentan (Tracleer®), macitentan (Opsumit®), and ambrisentan (Letairis®) widen your blood vessels.
- Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Revatio®, Viagra®) and tadalafil (Adcirca®, Cialis®, Alyq™) control blood flow to the pulmonary arteries and relax the blood vessels.
Supplemental oxygen, or oxygen therapy, can relieve shortness of breath and increase your tolerance for physical activities. There are several devices used in oxygen therapy. Your doctor can guide you in choosing the right oxygen delivery system based on your health needs, lifestyle, and insurance benefits. You may be prescribed one oxygen device to use at home and one to use when you are on the go.
- Dietary considerations - Certain foods can help you manage pulmonary hypertension. Opt for foods that are high in potassium, magnesium, and fiber, and limit foods that contain refined sugar, saturated fats, cholesterol, and sodium.
- Exercise considerations - Physical activity is integral to a heart-healthy lifestyle, and those with pulmonary hypertension can improve circulation by walking, but the condition may prevent more strenuous forms of exercise. Stop any activity that causes shortness of breath, dizziness, or chest pain, and check with your doctor about recommended exercises.
- Maintain a healthy weight - Pulmonary hypertension can lead to fluctuations in weight. It may be more difficult to gain weight due to the energy required to breathe. Conversely, fluid retention can lead to weight gain. As part of managing the condition, track your weight each day and inform your doctor if you gain two pounds in one day or five pounds in one week.
- Avoid lifting or pushing objects greater than 20 pounds, as this may increase the pressure in your arteries and lungs.
- Refrain from smoking and limit your alcohol consumption.
Take charge of your health
You can prevent certain forms of pulmonary hypertension by following a heart-healthy lifestyle and proactively managing related health conditions such as high blood pressure, coronary heart disease, and COPD.
At Alto, we make it as simple as possible to manage your risk for chronic health conditions and to stay on top of your cholesterol-lowering, blood pressure, or COPD medications. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.
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