Pulmonary hypertension occurs when the blood pressure in the pulmonary artery that goes from the heart to the lungs rises abnormally high. Elevated pressure in the pulmonary artery causes the heart to pump harder to circulate blood. The artery walls thicken from the continued high pressure narrowing the blood vessels even further. Eventually the added strain enlarges the right ventricle and may lead to heart failure.
The symptoms of pulmonary hypertension are vague and often go unrecognized in early stages of the condition. Symptoms include fatigue, dizziness or fainting, shortness of breath, swollen legs and ankles, chest pain, and a dry cough. Symptoms worsen as the condition progresses. Pulmonary hypertension is approximately twice as common in women as in men.
Pulmonary hypertension is a serious condition that requires treatment. Because the condition often is unrecognized in early stages, many patients are in advanced stages at the time of diagnosis. Heart failure due to a weakened right ventricle is the most common cause of morbidity. If left untreated, women with pulmonary hypertension have a median survival of 2.5 years after diagnosis.
However, treatments are available and the prognosis has improved considerably over the past two decades. Calcium channel blockers effectively control pulmonary hypertension, but only 5 percent of patients respond to treatment. For patients who respond, the 5-year survival rate is 90 percent, according to the Merck Manual.
After calcium channel blockers, epoprostenol is the most effective treatment. Epoprostenol is associated with a 54 percent 5-year survival rate. Lung transplant, reserved for the most severe cases, is the only option to cure pulmonary hypertension but it is associated with risks of rejection and infection. The 5-year survival rate for those who have had a transplant is 60 percent.
Factors Affecting Prognosis
What is the prognosis for pulmonary hypertension in elderly women? Pulmonary hypertension cannot be cured. Treatments only relieve symptoms and reduce the strain on the heart. The prognosis depends on the severity of the condition at the time of diagnosis, the status of any underlying medical conditions, and the patient’s response to treatment. Low cardiac output has a negative effect on the prognosis. The higher the pressure in the pulmonary artery and right ventricle, the more serious the condition and the worse the prognosis. Women who respond to calcium channel blockers and have mild disease have a more favorable outcome, but those who have underlying connective tissue disorders tend to have less positive results. Heart failure, reduced physical function, or a low level of oxygen in the blood worsen the prognosis.
PDRHealth: Pulmonary Hypertension
MedLinePLus: Pulmonary Hypertension
Science Daily: Predicting Survival for Pulmonary Hypertension Patients
Thenappan T, Shah SJ, Rich S, et al. Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation. Eur Respir J 2010:35:958-959. https://erj.ersjournals.com/content/35/5/1079
Pulmonary Hypertension Association: About PH
Merck Manual: Pulmonary Hypertension