Barriers to Care for Patients with Pulmonary Arterial Hypertension

EP: 1.Pathophysiology of Pulmonary Arterial Hypertension

EP: 2.Differential Diagnosis of Pulmonary Arterial Hypertension

EP: 3.Importance of Early Detection and Monitoring for Disease Progression

EP: 4.Risk Stratification and the Importance of Patient-Centered Care

EP: 5.Strengths and Limitations of Current Therapeutic Options

EP: 6.Overview of Different Therapies for Patients with Pulmonary Arterial Hypertension

EP: 7.Sotatercept for Patients with Pulmonary Arterial Hypertension

EP: 8. The Role of the Prostacyclin Pathway

EP: 9.Important Clinical Considerations for Pulmonary Arterial Hypertension

EP: 10.Economic Impact of Pulmonary Arterial Hypertension

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EP: 11.Barriers to Care for Patients with Pulmonary Arterial Hypertension

Managing Comorbidities and Complex Patients

Managing PAH patients with significant comorbidities requires comprehensive evaluation to distinguish true Group 1 PAH features from pulmonary hypertension secondary to underlying cardiac or pulmonary disease. The patient spectrum ranges from young adults with isolated severe PAH to elderly patients with multiple comorbidities including hypertension, diabetes, and coronary disease who also have significant pre-capillary pulmonary hypertension. Careful phenotyping is essential to determine appropriate treatment approaches.

When Group 1 PAH features can be established despite comorbidities, treatment approaches typically involve more cautious, measured strategies rather than aggressive upfront combination therapy. Initial single-agent therapy with careful tolerance monitoring followed by gradual escalation is often preferred over immediate multi-drug regimens. This approach helps identify potential complications such as pulmonary edema or worsened hypoxemia while ensuring appropriate treatment intensity.

The challenge lies in determining the threshold of comorbidity burden that warrants more conservative treatment approaches versus standard aggressive PAH therapy. Older patients with multiple comorbidities require closer monitoring for side effects and complications, while younger patients with isolated PAH may warrant standard intensive treatment despite comorbid conditions. Clinical judgment must integrate comprehensive evaluation results with individual patient characteristics to optimize treatment strategies.