Sandeep Sahay, Rodolfo A. Estrada, Megan Griffiths, Naomi Habib, Sandhya Murthy, Steven D. Nathan, Rachel T. Sullivan, James R. Klinger, Raymond Benza
Houston Methodist Hospital. UT Health San Antonio. Children’s Medical Center Dallas and University of Texas Southwestern. Norton Thoracic Institute. Montefiore-Einstein Heart Center. Inova Fairfax Hospital. Monroe Carell Jr. Children’s Hospital and Vanderbilt University. Rhode Island Hospital and Alpert Medical School of Brown University. Eastern Virginia Medical School, Macon and Joan Brock Virginia Health Sciences at Old Dominion University and Sentara Health.
United States
Chest
Chest 2026;
DOI: 10.1016/j.chest.2026.05.009
Abstract
Importance: Pulmonary hypertension (PH) represents a pathophysiologically diverse and clinically intricate spectrum of disorders characterized by elevated pulmonary arterial pressures and progressive right ventricular dysfunction. The management of PH has evolved considerably over recent decades; these developments underscore the dynamic nature of the field and the necessity for continual reappraisal of diagnostic and therapeutic frameworks. The European Society of Cardiology and Respiratory Society (ESC/ERS) and the World Symposium on Pulmonary Hypertension (WSPH) were pivotal in addressing key PH topics, including hemodynamic definitions, disease classification, risk stratification and evolving therapeutic agents, and generating consensus-driven recommendations that shape global clinical practice.
Review findings: The ability to translate these global recommendations to clinical practice within the United States may be limited by inherent differences in healthcare access, population-specific disease modifiers, unique pulmonary arterial hypertension (PAH) subtypes, clinical practice preferences and comorbidities.
Summary: The recent clinical trials have introduced new therapies and indications that are reshaping the treatment landscape, yet these developments have not been addressed in guidelines or reviews from professional societies in the US. The purpose of this review is to synthesize and interpret the latest international recommendations from a US perspective. We discuss multiple barriers to implementation of these recommendations, addressing racial, ethnic and geographic disparities, treatment costs, and insurance limitations that are unique to the US healthcare system, and its effects on treatment delays and patient outcomes. Ultimately, this provides a framework for the development of a roadmap to increasing the quality of PH care in the US.
Category
Review Articles Concerning Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease or Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: No