Why is this a problem?
When you hear the word hypertension, you probably know that it means high blood pressure. Usually, blood pressure is related to your heart and cardiovascular system. Pulmonary hypertension is not different in this regard, but it also involves your lungs. It can be a very serious condition. So, how do you know if you have it? What can you do to treat it?
Pulmonary hypertension is when you have high blood pressure in the blood vessels, usually the arteries, of your lungs. Since blood flow to your lungs is supplied by the right side of your heart, it also affects this as well. In order to understand why this is the case, we need to take a closer look at how blood flows to and from your pulmonary blood vessels. Your heart has four main chambers with the top two being the atria and the bottom two being the ventricles. Deoxygenated blood from your body enters your heart in the right atria. Next, it passes in to your right ventricle before being sent to your lungs via your pulmonary arteries. While in your lungs, it releases carbon dioxide and picks up oxygen. Traveling back to your heart via your pulmonary veins, the oxygenated blood ends up in your left atria. From there, it passes through your left ventricle before being pumped out to the rest of your body. The blood delivers oxygen and picks up carbon dioxide throughout your body before making its way back to your right atria. Then, the process repeats all over again. It’s important to note that your blood usually flows to and through the pulmonary arteries, capillaries (smallest of the blood vessels and is where the exchange of oxygen and carbon dioxide takes places) and veins relatively easily. This means the blood pressure in your lungs is much lower. When you have increased pressure, as is the case in pulmonary hypertension, it causes significant changes to the blood vessels. It can cause the arteries to become stiff, thick, inflamed, tight and result in extra tissue forming. All of these changes reduce or block blood flow, which makes the hypertension worse.
Pulmonary hypertension is categorized into five groups based off of the cause. The first is called pulmonary arterial hypertension. For some individuals, there isn’t a known cause, so it’s referred to as idiopathic pulmonary arterial hypertension. Other individuals have a specific genetic mutation which results in the development of the disease, so it’s known as heritable pulmonary arterial hypertension. Some other possible causes of this type of pulmonary hypertension are the use of certain medications or drugs, heart abnormalities that are usually present at birth and other conditions. The second group is pulmonary hypertension caused by left-sided heart disease which is when one of the two, or both, of the valves in the left side of the heart aren’t working or the left ventricle isn’t functioning properly. The third group is pulmonary hypertension caused by lung disease, such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, sleep apnea and living at high altitudes (especially if you have other risk factors). The fourth group is pulmonary hypertension caused by chronic blood clots that either originate from or end up in the blood vessels of your lungs. The fifth group is pulmonary hypertension associated with other conditions, but the reasons why it’s associated is unclear. Some of these conditions are blood disorders, disorders that affect several organs in your body, metabolic disorders and tumors pressing on the pulmonary arteries.
The main risk factors for developing pulmonary hypertension are being overweight, having a family history of the disorder, use of illegal drugs or certain appetite-suppressant medications, you have another condition that is associated with the development of the disorder or you’re a young adult (this is for idiopathic pulmonary arterial hypertension only). The main symptom of pulmonary hypertension is shortness of breath. Typically, you first notice feeling short of breathing when you’re exerting yourself, such as while exercising. Eventually, it occurs when you’re just sitting. Other symptoms include fatigue, dizziness, fainting, chest pain/pressure, racing heart rate, palpitations, bluish color to your lips/skin and swelling to your ankles/legs and your stomach. It can take years for symptoms to become perceptible. This is why that it’s not usually caught until later stages, which means that it typically results in the development of several complications. The most common complication of pulmonary hypertension is cor pulmonale, which is the enlargement and failure of the right side of your heart. This happens because the right side of your heart has to pump your blood through the narrowed space of your pulmonary arteries. By increasing in size, it initially helps with this. Overtime, the effectiveness decreases and your blood backs up (this is what results in your feet and legs being swollen). Some other complications of pulmonary hypertension are increased number of blood clots in your lungs, irregular heart rhythms and increased risk of bleeding in your lungs.
Pulmonary hypertension can’t be cured, so the goal is to manage symptoms and slow the progression of the disease. The treatment depends on the severity of your symptoms. Your doctor will rank it on a I – IV scale. If you don’t have any symptoms, but have been diagnosed with pulmonary hypertension, then you’ll be classified as a I. You’re considered to be a II if you don’t have symptoms at rest, but experience fatigue, shortness of breath or chest pain when being physically active. If you have any symptoms with normal activities, but not will at rest, then you’re a III. If you have symptoms all of the time, even while at rest, you’re a IV. One of the main focuses of treatment is to dilate your blood vessels in order to decrease the pressure and make it easier for blood to flow through them. These medicines can be taken as a pill, injected intravenously or inhaled directly into your lungs. Depending on what your doctor feels will work best for you, they will prescribe the most appropriate option. Some medications can help to relax the blood vessels making them less stiff. The two main classifications are high doses of calcium channel blockers or soluble guanylate cyclase (SGC) stimulators. Your doctor might prescribe a medication, called digoxin, to help your heart beat stronger and control the rate of it (this is especially important if you are having irregular heart rhythms). If you have swelling to your feet and legs, you might need to take diuretics (water pills) to help get rid of this extra fluid. Due to the increased risk for developing blood clots, you will most likely need to take some form of anticoagulant. These medications help to prevent the formation of clots by inhibiting the clotting factors in your blood. If the shortness of breath you are having is significant, you might need to be on supplemental oxygen. For severe cases that don’t respond to other forms of treatment, you might need to have a surgery called atrial septostomy. During this procedure, your doctor will relieve the pressure on the right side of your heart by creating an opening between your right and left atria. The other surgical option is to have a heart or heart and lung transplant.
In addition to taking medications, there are things that you can do at home to improve your quality of life. It’s essential to get as much rest as possible to avoid fatigue. If you can tolerate it, exercising can be a good way to help reduce your blood pressure. Be sure to ask your doctor about exercises that would be right for you before starting any programs. If you’re a smoker, you should quit. If you don’t smoke, don’t start and avoid being around those who do. Don’t use illegal drugs or medications that can make your symptoms worse. If you are female who is of childbearing age, you need to talk to your doctor about which type of birth control would be best for you because they can significantly increase your risk of developing blood clots. Also, you should talk to your doctor before becoming pregnant because pulmonary hypertension can cause serious complications for you and your fetus. Avoid doing activities that might suddenly lower your blood pressure, like sitting in a hot tub/sauna or taking long hot baths/showers, because this can result in you fainting and possibly dying. The same thing applies to prolonged straining, such as lifting heavy objects. Eating a nutritious diet is key to maintaining a healthy weight. Make sure to get the flu and pneumonia vaccines yearly because if you end up contracting either of these, you can have serious complications.
The prevention of pulmonary hypertension can be done by following some of the previously mentioned lifestyle recommendations. Getting plenty of regular exercise and enough sleep every night is essential. Eating a nutritious diet in order to maintain a healthy weight is vital. All of these significantly impact your blood pressure throughout your entire body, not just your pulmonary blood vessels, which means your overall health will improve. Don’t smoke, use illegal drugs or use medications that increase your risk of developing pulmonary hypertension.
Pulmonary hypertension is a very serious disease. Unfortunately, many people don’t realize that they have it until the disease is well advanced. It is possible to have a good quality of life by maintaining control over your symptoms. If you have any questions or concerns about pulmonary hypertension, please speak with your doctor. If you would like more information, please visit the American Heart Association (AHA) Pulmonary Hypertension page at https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/pulmonary-hypertension-high-blood-pressure-in-the-heart-to-lung-system