Pulmonary hypertension risk factors: who is more likely to develop it

What pulmonary hypertension is

Pulmonary hypertension is a condition that affects the blood vessels in the lungs. It develops when the blood pressure in your lungs is higher than normal. About 1% of people globally have pulmonary hypertension (NHLBI).

Blood moves from your heart to your lungs through blood vessels called pulmonary arteries. If these arteries become damaged, narrowed, or blocked, the blood does not flow through them as well, which can raise the pressure in the arteries and cause pulmonary hypertension (MedlinePlus). The heart then has to work harder than normal to pump blood into the lungs, which can damage the heart and cause symptoms (NHLBI).

The NHLBI describes five groups of pulmonary hypertension (NHLBI):

• Group 1: pulmonary arterial hypertension (PAH)
• Group 2: pulmonary hypertension due to left-sided heart disease
• Group 3: pulmonary hypertension due to lung disease and/or hypoxia (low oxygen)
• Group 4: pulmonary hypertension due to blockages in the pulmonary arteries, including chronic thromboembolic pulmonary hypertension (CTEPH)
• Group 5: pulmonary hypertension with unknown and/or multiple causes

Over 50% of pulmonary arterial hypertension cases worldwide have no known cause. In the United States, the most common type is caused by left-sided heart disease, such as left heart failure (NHLBI).

Conditions that can cause it

The cause is not always clear. Certain medical conditions can damage, change, or block the pulmonary arteries, which can lead to pulmonary hypertension (NHLBI). Examples include:

• Left heart diseases, such as left heart failure, which may be caused by high blood pressure throughout your body or coronary heart disease (NHLBI).
• Other heart and blood vessel diseases, such as congenital (inherited) heart defects (NHLBI).
• Lung diseases, such as COPD, interstitial lung disease, emphysema, or sleep apnea (NHLBI).
• Other medical conditions, such as liver disease, sickle cell disease, blood clots in the lungs, or connective tissue disorders like scleroderma (NHLBI).

Who is more likely to develop it

Several factors can increase your risk of developing pulmonary hypertension (NHLBI):

• Age: it can occur at any age, but the risk increases as you get older. It is usually diagnosed between ages 30 and 60 (NHLBI).
• Environment: having or being exposed to asbestos, or certain infections caused by parasites (NHLBI).
• Family history and genetics: certain genetic disorders, such as Down syndrome, congenital heart disease, and Gaucher disease, can raise your risk. A family history of blood clots also increases your risk (NHLBI).
• Lifestyle habits: smoking and illegal drug use (NHLBI).
• Medicines: some prescribed medicines used to treat cancer and depression may increase your risk (NHLBI). The NHLBI suggests talking to your doctor about your risk factors and concerns (NHLBI).
• Sex: pulmonary hypertension is more common in women than in men. Pulmonary hypertension with certain types of heart failure is also more common in women (NHLBI).

MedlinePlus lists the same factors: age, environment, family history and genetics, lifestyle habits, certain medicines, and sex (MedlinePlus).

Symptoms

Symptoms are sometimes hard to recognize, and people may have them for years before being diagnosed, because many of them are also symptoms of other conditions (NHLBI). They include chest pain, a cough that is dry or produces blood, shortness of breath, dizziness that may lead to fainting, nausea and vomiting, hoarseness, fatigue, swelling of the abdomen, legs, or feet, weakness, and wheezing (NHLBI). MedlinePlus also lists heart palpitations, the feeling that your heart is pounding or beating too fast (MedlinePlus).

Symptoms can get worse over time. Early on, you may only be short of breath with exercise; as the disease progresses, shortness of breath happens more often (NHLBI).

Problems it can lead to

Pulmonary hypertension can get worse over time and lead to serious problems, including anemia, arrhythmias (problems with the rate or rhythm of the heartbeat), blood clots in the pulmonary arteries, bleeding in the lungs, heart failure, liver damage, fluid around the heart (pericardial effusion), and serious pregnancy complications (MedlinePlus).

Prevention and diagnosis

Prevention is not always possible, because the cause is not always clear. Your doctor may suggest a preventive screening if you have a known risk factor or a medical condition that causes pulmonary hypertension (NHLBI). To find out if you have it, a provider will ask about your history and symptoms, do a physical exam, and will likely order tests such as blood tests, heart and lung imaging, and an electrocardiogram (ECG) (MedlinePlus). Often there is no cure, but treatment based on the cause can help manage the symptoms (MedlinePlus).

Common questions

What is the most common cause of pulmonary hypertension?

In the United States, the most common type is caused by left-sided heart disease, such as left heart failure (NHLBI).

What are the risk factors for pulmonary arterial hypertension?

Over 50% of pulmonary arterial hypertension cases worldwide have no known cause (NHLBI). The NHLBI lists older age, asbestos or certain parasite infections, some genetic disorders and a family history of blood clots, smoking, illegal drug use, some cancer and depression medicines, and female sex as factors that raise the risk of pulmonary hypertension (NHLBI).

Is pulmonary hypertension the same as high blood pressure?

No. Pulmonary hypertension is high blood pressure in the lungs (NHLBI). High blood pressure throughout the body is one possible cause of left heart failure, which can in turn lead to pulmonary hypertension (NHLBI).