Advanced therapeutic options in pulmonary hypertension: who, what and when?

Abstract Pulmonary hypertension (PH) is the common hemodynamic consequence of various pathophysiologic mechanisms. Since the publication of the most current American and European guidelines (2009) new agents were introduced into the clinical arena while data regarding former drugs has been substantiated. The therapeutic endeavor of evaluating new therapies for PH targets patients based on their PH type and symptom severity with the hope to demonstrate hemodynamic and functional benefits along with reduction in morbidity and mortality. Although patients' outcomes (predominantly among type I and IV) have improved, the hemodynamic and symptomatic benefit is modest and not uniform. The purpose of this review is to objectively assess the benefits of the currently available dedicated agents. It is our hope that with early detection and careful individual titration of new combination therapy in expert hands, we will better serve a larger proportion of our PH patients.