What Is Pulmonary Hypertension? 

Last updated: February 2021

Some people with COPD may develop a condition called pulmonary hypertension (PH). So, what is pulmonary hypertension? What does it mean for you? What are the treatments? Here’s what to know.

What is pulmonary hypertension?

Pulmonary hypertension basically means you have high blood pressure in your lungs.1-7 Inside your lungs, you have over 200 million alveoli. These are small, balloon-like structures that collect oxygen when you inhale. Each one of these alveoli is connected to blood vessels.1-3

Veins are blood vessels that do not contain oxygen. Venous blood travels from all the tissues of your body to the right side of your heart. Your right heart then pumps it through your lungs. Your lungs are normally very compliant. This means that your heart does not have to work hard to pump blood through them. When your lungs are healthy, your right heart easily pumps blood through your lungs. For this reason, the blood pressure inside your pulmonary vessels is generally very low.1-2

Venous blood travels from your right heart to the alveoli where it picks up oxygen. Oxygenated blood is then called arterial blood. This blood is transported from your lungs to the left side of your heart. Your left heart then pumps arterial blood to all the tissues of your body.2

Sometimes, the vessels inside your lungs become abnormally narrow. This means your right heart has to work extra hard to pump blood through them. The pressure it must generate to do this is higher than normal - this is referred to as pulmonary hypertension.1,4-7 A good way to monitor your pulmonary blood pressure is by determining your pulmonary artery pressure (PAP). Pulmonary hypertension is defined as having a PAP greater than 25 mm Hg at rest or greater than 30 mmHg with exertion. Some tests that determine your PAP are described below.4

Symptoms

PH is generally considered to be mild to moderate when combined with COPD.1  Initially, PH may only occur when you are exerting yourself. Your pulmonary blood pressure may increase when you are exercising so you may feel short of breath with exertion.4 Over time, PH may become more prevalent and chronic. Some of its symptoms mimic COPD's: shortness of breath, chest tightness, and fatigue. It may also cause dizziness, increased heart rate, or other symptoms. Symptoms may be more prevalent or get worse when you are exercising.4-6

After years of pumping blood through narrow arteries, your right heart may become enlarged. A term for a large heart is hypertrophy and a large right heart due to diseased lungs is often referred to as cor pulmonale. This makes your right heart a weaker pump. A term for this is right heart failure.1,4-5

Since your heart is a weaker pump, it is less effective at pumping blood through your pulmonary vessels. Blood may get backed up in your veins. A common sign of this is swelling in your feet and ankles. Another sign is when the jugular veins on either side of your neck become large and distended. A term for this is jugular venous distention (JVD).1,5,7

Diagnosis

Doctors may watch for the signs of PH in people with COPD which explains why your doctor might check your feet and neck. It’s easy to see if you have ankle or foot swelling or signs of JVD. Your doctor may also ask if you have noticed any swelling of your ankles, feet, or legs. If you already have foot and ankle edema, you may be asked if you have noticed it getting worse.7 Your doctor may order blood tests. If you have heart failure, your heart will secrete B-type natriuretic peptide (BNP). So, your doctor will want to monitor your BNP level.7

An x-ray will show if you have an enlarged heart. An echocardiogram gives your doctor an idea of how blood flows through your heart. It can also determine what your pulmonary blood pressure is. A heart catheterization can also be used to determine your pulmonary blood pressure. It can also show if you have any heart abnormalities that may contribute to your symptoms, such as damaged heart valves. A CT may also help doctors diagnose PH. It will show if you have an enlarged heart, among other things.7

Treatment

Like COPD, there is no cure for pulmonary hypertension. Also like COPD, various treatment strategies can help reduce symptoms and improve your overall quality of life. The most basic treatment is to receive appropriate care for your COPD. Having you wear oxygen long-term may also help with pulmonary hypertension, especially true if low oxygen levels were a contributing factor to its formation.4-5

Various medicines can help lower your pulmonary blood pressure. Examples here include Adempas, Tracleer, Opsumit, Letairis, Revatio, Viagra, Norvasc, and Cardizem. Through various mechanisms, they reverse vasoconstriction or dilate pulmonary blood vessels. This can help blood flow more easily through your lungs, thereby reducing the force your heart needs to produce to pump blood through them. In turn, this lowers your pulmonary blood pressure.5 Medicines like Digoxin may increase the strength and contractility of your heart. This makes your heart a better pump. Medicines like Lasix can help you pee. This can reduce the amount of fluid your heart has to pump through your body.5

There may also be other options you may discuss with your doctor. Of course, determining what treatments are best for you is a matter of weighing the potential benefits with potential side effects.

The importance of early diagnosis

Not everyone with COPD will develop pulmonary hypertension. Still, it is a condition that may develop as the disease progresses. One of the best ways of preventing PH is with an early diagnosis of COPD and aggressive treatment to improve symptoms and slow the progression. Your doctor may also screen you regularly for the signs of PH. If you are diagnosed, various treatments can help reduce symptoms.

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