Study finds high mortality burden, premature deaths with mild pulmonary hypertension

Individuals with mildly elevated estimated right ventricular systolic pressure had a high burden of mortality and consequential premature deaths, researchers reported in the European Respiratory Journal.

“Our findings support the contention that even subclinical pulmonary hypertension has an extensive clinical impact,” Simon Stewart, MD, professor and senior principal research fellow in the Centre for Cardiopulmonary Health at Torrens University Australia, Adelaide, and the School of Medicine, Dentistry and Nursing at the University of Glasgow, U.K., and colleagues wrote.

The researchers aimed to determine the impact of pulmonary hypertension on premature mortality by conducting a large real-world echocardiographic database study. The study included 70,826 men (mean age, 61.3 years) and 84,130 women (mean age, 61.4 years) with no evidence of left heart disease assessed by echocardiography. Researchers studied the distribution of estimated right ventricular systolic pressure (eRVSP) and examined individually linked mortality, premature mortality and associated life-years lost based on eRVSP levels.

Fifty-five percent of participants had eRVSP levels indicative of no pulmonary hypertension (< 30 mm Hg), 31.8% mild pulmonary hypertension (30-39.9 mm Hg), 8.4% moderate pulmonary hypertension (40-49.9 mm Hg) and 4.8% severe pulmonary hypertension ( 50 mm Hg).

During a median of 5.7 years of follow-up, 24.8% of participants died. Fifty-four percent of men and 55% of women died prematurely, according to the researchers.

After adjusting for age and sex, there were higher rates of all-cause (HR = 1.9; 95% CI, 1.84-1.96) and cardiovascular-related mortality (HR = 1.85; 95% CI, 1.74-1.97) for individuals with an eRVSP of 35 mm Hg to 39.9 mm Hg compared with an eRVSP of less than 30 mm Hg.

Premature mortality, as a proportion of all deaths, increased from 46.7% to 79.2% among participants with an eRVSP less than 30 mm Hg compared with participants with an eRVSP of 60 mm Hg or more.

An eRVSP of 30 mm Hg to 39.9 mm Hg was associated with 58% of total life-years lost among men and 53% of life-years lost among women.

“We propose increased clinical risks starting at eRVSP levels around 30 mm Hg and recommend early monitoring from treating clinicians with efforts to modify risk factors and improve outcome weighted against the likely increased economic burden of additional screening and increased referrals of advanced pulmonary hypertension,” the researchers wrote. “Furthermore, more granular work is warranted to determine if early aggressive management of risk factors in individuals with mildly elevated eRVSP can significantly increase survival and reduce a high burden of premature mortality and associated life-years lost.”