Hipertensión pulmonar en la EPOC: puesta al día

Summary Pulmonary hypertension (PH) is a common complication of chronic respiratory diseases and, in particular, chronic obstructive pulmonary disease (COPD). In most cases it is mild, with low progression and is associated with concomitant diseases that should be diagnosed and treated. Its appearance and progression have a strong impact on the functional capacity and survival of these patients. Although it is closely related to the severity of airflow obstruction, not always is the case and it can be seen in earlier stages of the same. A small proportion of patients may develop severe PH associated with mild to moderate bronchial obstruction, severe hypoxaemia, hypocapnia and very low lung diffusion capacity. It has been called “PH out of proportion” and it is associated with high mortality and rapid functional worsening, similar to idiopathic pulmonary arterial hypertension. The diagnosis is confirmed by right heart catheterization which is reserved for selected cases. Management of PH in COPD relies on ruling out comorbidities, optimising therapy for COPD and long-term domiciliary oxygen therapy. At present, there is no evidence that PH in COPD would benefit from any specific vasodilator therapy.