Outcome of mean pulmonary arterial pressure-based intensive treatment for patients with pulmonary arterial hypertension

Background: Mean pulmonary arterial pressure (mPAP) has not been recognized as a therapeutic target for pul-monary arterial hypertension (PAH). However, previous reports demonstrated that the survival of patients with some types of pulmonary hypertension was associated with mPAP. Therefore, we treated all subsets of PAH pa-tients with the aim of lowering mPAP and evaluated the efficacy of the treatment algorithm. Method: From September 2014 to August 2019, 43 consecutive patients with PAH on treatment <3 months on referral were enrolled in this study. They were treated according to our treatment algorithm mainly based on World Health Organization functional class, mPAP, and percent predicted diffusing capacity of the lung for carbon monoxide. The therapeutic goal was the achievement of mPAP <40 mmHg at follow-up. We evaluated clinical parameters, survival rate, and its determinants. Survival analyses were conducted using the Kaplan-Meier method and the relationship between all-cause death and selected variables was analyzed using the Cox propor-tional hazards model for mortality. Results: mPAP significantly improved at the last follow-up [45 (35-55) mmHg to 24 (19-30) mmHg, p < 0.05], and the therapeutic goal was achieved in 37 patients (86%). The 5-year survival rate of all patients was 90.7%. The survival rate of patients who achieved the therapeutic goal (3-and 5-year survival: 97.3%) was significantly better than that of the patients who did not achieve the therapeutic goal (3-year survival: 50.0%, p < 0.05). The 5-year survival rates of the patients were the same among different treatment regimens (p = 0.985). mPAP <40 mmHg at follow-up was the independent predictor of survival. Conclusions: Lowering mPAP resulted in favorable outcomes in all subsets of PAH patients, making it a therapeutic goal. (C) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.