Prognostic Factors for Pulmonary Hypertension Include Gender, Age, Chronic Diseases, Study Suggests

A new study published in the Journal of the American Heart Association reports that, in people with pulmonary hypertension (PH), females, middle-aged patients, and those with chronic diseases have an increased risk of mortality.

Most current knowledge comes from small-scale or specialized studies. This is the first Taiwan nationwide retrospective study to address several variables that can be used as prognostic factors for the assessment of mortality among PH patients.

The study, “Prognostic Factors in Patients With Pulmonary Hypertension — A Nationwide Cohort Study,” was conducted by Dr. Wei-Ting Chang, MD, and colleagues from medical centers in Taiwan.

Researchers used data from the Longitudinal Health Insurance Database, a subset of the National Health Insurance (NHI) database. They created two groups from the data: the PH group, with information relative to 1,092 newly identified patients between 1999 and 2011, and the control group, with data on 8,736 healthy people.

PH patients were identified according to their clinical symptoms and a pulmonary artery pressure above 25 mm Hg. Eight control subjects were matched to each PH patient according to age, sex, and chronic cardiovascular risk factors to ensure a proper comparison between participants.

The parameters analyzed were gender, age, presence of chronic diseases, causes for the development of PH (etiology) and outcome. Age was classified into three categories: less than 50, 50 to 64, and more than 60 years. The chronic diseases analyzed in the study were hypertension, diabetes mellitus, hyperlipidemia, and coronary artery disease.

In terms of etiology, patients were also categorized depending on whether they had connective tissue diseases (CTDs), congenital heart disease (CHD), pulmonary embolism, idiopathic pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). Regarding clinical outcome, patients were analyzed in terms of mortality or hospitalization within 30 days after they were diagnosed with PH.

“(…) compared with the matched cohort without PH, the mortality rate was up to three times higher in the patients with PH,” the authors wrote in their report.

Moreover, “mortality was associated with male sex, older age, and concomitant comorbidities,” although “a younger age and female sex were more significantly associated with mortality compared to the control group.” The team also observed that COPD and pulmonary embolism increased the mortality risk among PH patients.

“These findings should alert clinicians to the importance of detecting the development of PH at an early stage and also to treat combined chronic diseases,” the authors wrote. “In addition to focusing on older patients, younger female patients may also be at a high risk and require an early and appropriate diagnosis.”

PH is a rare but fatal disease characterized by an increase in the blood pressure of the lung vasculature, such as the pulmonary artery, pulmonary vein, and pulmonary capillaries. Clinical manifestations include decreased exercise tolerance, shortness of breath, dizziness, fainting, and leg swelling.