CHEST Guidelines-COUNTERPOINT--Should-the-New-Definition-of-PH-Be-t

COUNTERPOINT--Should-the-New-Definition-of-PH-Be-t

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Dr. Robert P. Frantz argues against adopting the revised definition of pulmonary hypertension (PH) as the clinical practice standard. He outlines three primary concepts that underpin the new definition: a mean pulmonary artery pressure greater than 20 mm Hg being abnormal, mild PH associating with increased risk across diseases, and significant obliteration of the vascular bed necessary to result in PH. However, Dr. Frantz believes additional considerations are needed for clinical practice adoption.<br /><br />The primary concerns include the insufficient evidence for these requirements leading to tangible patient benefits, potential increased unnecessary diagnostic procedures, and the variable expertise in proper hemodynamic measurements. Such procedures might lead to potential harm, costs, and psychological distress for patients. Mild PH's presence does not necessarily indicate group I pulmonary arterial hypertension (PAH), and many mild PH cases are not related to PAH. <br /><br />Furthermore, treatments based on the revised definition may not benefit patients and often do not address the fundamental issues contributing to delayed diagnoses, such as lack of consideration in symptom evaluation. The new definition's variability in diagnostic criteria due to measurement errors also diminishes its appropriateness for regular practice.<br /><br />Dr. Frantz emphasizes that more than revising the definition, addressing the hindrances in timely diagnosing symptomatic patients is crucial. He advises that patients meeting the new hemodynamic guidelines should be managed through expert centers and research trials instead of routine clinical practice, underscoring that this broader PH definition could result in unnecessary treatments and diagnostic procedures without evident patient benefits.

Keywords

pulmonary hypertension

PH definition

clinical practice

Dr. Robert P. Frantz

hemodynamic measurements

diagnostic procedures

patient benefits

mild PH

vascular bed

symptom evaluation