Pulmonary hypertension (PH) is a serious condition that occurs when the blood pressure in the pulmonary arteritis is comparatively higher than usual. Pulmonary arteries are a type of blood vessel that is responsible for oxygen-rich blood from the heart to the lungs. It impacts the right side of the heart and arteries in the lungs. There can be various causes influencing the onset of pulmonary hypertension. It is a common complication caused due to health problems like heart disease and lung disease. As it significantly restricts the blood flow to your heart and lungs, it is a life-threatening disease.

It can lead to the narrowing down of your pulmonary artery. As a result, the walls of your pulmonary arteries become stiff and thick over time. It is challenging for your heart to pump harder than usual to regulate oxygen-rich blood flow to the lungs. If not treated on time, it can cause further complications such as anemia (lack of healthy blood cells), arrhythmia (a condition leading to irregular heartbeat), and blood clots in your pulmonary arteries.

Symptoms of pulmonary hypertension

Here are common signs and symptoms of pulmonary hypertension as per the American Heart Association:

• Shortness of breath
• Lightheadedness
• Fatigue
• Chest pain
• Palpitations (heartbeat rate increased)
• Right-sided abdominal pain
• Poor appetite
• Fainting
• Swelling (legs/ankles)
• Coughing and wheezing
• Bluish color of the lips or skin (Cyanosis)

Causes of pulmonary hypertension

PH develops when the cells lining the walls of the pulmonary arteries undergo changes that make the arteries narrow, stiff, swollen, and thickened. “These alterations, often due to underlying conditions such as heart diseases, lung disorders, or genetic factors, disrupt the normal flow of blood from the heart to the lungs. As a result, the pressure within the pulmonary arteries increases, putting strain on the heart and potentially leading to complications such as heart failure,’ says Dr Samir Garde, a pulmonologist. The narrowed arteries limit the amount of blood that can pass through, reducing oxygen delivery to the body and causing symptoms like shortness of breath, fatigue, and chest pain.

Pulmonary hypertension is classified into 5 groups based on its cause, according to the American Lung Association:

1. Group 1: Pulmonary arterial hypertension (PAH)

This group includes idiopathic PAH, heritable PAH (due to genetic factors), and PAH associated with connective tissue diseases, congenital heart diseases, drugs/toxins, and other conditions.

2. Group 2: Pulmonary hypertension due to left heart disease

Elevated pressures in the pulmonary circulation are due to left-sided heart diseases such as heart failure or valvular diseases.

3. Group 3: Pulmonary hypertension due to lung diseases

PH is caused by chronic respiratory diseases like COPD, interstitial lung disease, and sleep apnea that lead to low oxygen levels (hypoxia).

4. Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH)

PH is caused by blood clots (thromboemboli) in the lungs, called pulmonary emboli, which fail to dissolve over time and obstruct blood flow.

5. Group 5: Pulmonary hypertension due to other disorders

PH is associated with a variety of conditions that do not fit into the other groups, including blood disorders, metabolic disorders, and other conditions.

Who is at risk of pulmonary hypertension?

“Pulmonary hypertension usually affects people aged 30 to 60. Its early signs and symptoms can mimic those of various other medical conditions, making early detection challenging,” explains Dr Garde. Several factors that can heighten the risk of developing pulmonary hypertension include:

• Family history of the condition
• Advancing age
• Exposure to Asbestos
• Being overweight or obese
• Unhealthy lifestyle habits such as smoking
• Certain drugs used to treat cancer and depression
• Gender: It is more common in women than men

Diagnosis of pulmonary hypertension

Your healthcare provider will start by gathering information about your medical history and discussing your symptoms. A physical examination will follow, including assessments of blood oxygen levels, heart and lung sounds, and blood pressure readings. Additionally, your doctor may recommend the following tests:

• Blood tests to check for conditions like blood clots, heart strain, or anemia
• Heart imaging tests, such as a cardiac MRI
• Echocardiograph (echo)
• Lung imaging tests, such as chest X-ray
• Electrocardiogram (ECG or EKG)
• Exercise test to monitor heart rate, blood pressure, and oxygen levels
• Right heart catheterization, where a thin tube (catheter) is inserted into a vein in your neck, arm, or groin and passed through to your pulmonary artery

Treatment of pulmonary hypertension

Pulmonary hypertension has no cure. Treatment aims to manage symptoms and prevent further lung damage. The approach depends on identifying whether the condition is arterial, venous, hypoxic, thromboembolic, or of other types. Direct treatment options exist for only two types: pulmonary artery hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Managing underlying medical conditions that contribute to the condition, such as obstructive sleep apnea, lung diseases, and heart valve issues, is crucial.

“PAH is treated with a combination of medical procedures such as oxygen therapy, diuretics, calcium channel blockers, and pulmonary vasodilators. Available options for treating CTEPH include anticoagulants, balloon atrial septostomy (BAS), balloon pulmonary angioplasty (BPA), pulmonary endarterectomy (PEA), and certain medications. Your doctor might also suggest some adjustments like dietary changes, lifestyle changes, oxygen therapy, and even heart valve repair surgery in some cases,” explains Dr Garde.

Tips for pulmonary hypertension

These 5 lifestyle and other tips can help improve your symptoms:

1. Quit smoking

Smoking worsens PH by constricting blood vessels, increasing heart rate, and reducing oxygen in the blood. Quitting can slow disease progression and improve lung function.

2. Eat a healthy diet

Follow a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to support heart and lung health. Limit salt, sugar, saturated fat, and trans fat intake.

3. Maintain a healthy weight

Maintaining a healthy weight reduces strain on the heart and improves overall cardiovascular function, which is essential in managing PH.

4. Stay active

Regular physical activity can improve blood circulation, lung function, and overall fitness. Avoid straining or lifting heavy weights and rest when you need to.

5. Avoid high altitudes

“High altitudes reduce oxygen levels in the air, exacerbating symptoms of PH. Be careful or avoid travel to high-altitude locations to manage symptoms and prevent complications,” suggests Dr Garde.

Do not forget to get regular health checkups to diagnose the condition at an early stage.