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Original Research: Pulmonary Vascular Disease |

Causes of Pulmonary Hypertension in the ElderlyPulmonary Hypertension in the Elderly

Meredith E. Pugh, MD; Lakshmi Sivarajan, MD; Li Wang, MS; Ivan M. Robbins, MD; John H. Newman, MD; Anna R. Hemnes, MD
Author and Funding Information

From the Division of Allergy, Pulmonary, and Critical Care Medicine (Drs Pugh, Robbins, Newman, and Hemnes), and the Department of Biostatistics (Ms Wang), Vanderbilt University Medical Center; and the Vanderbilt University School of Medicine (Dr Sivarajan), Nashville, TN.

CORRESPONDENCE TO: Meredith E. Pugh, MD, MSCI, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, T1218 Medical Center N, 1161 21st Ave S, Nashville, TN 37232; e-mail: meredith.e.pugh@vanderbilt.edu


Preliminary data from this study were presented at the American Thoracic Society International Conference, May 18-23, 2012, San Francisco, CA.

FUNDING/SUPPORT: This work was supported by the National Institutes of Health, supported in part by the Vanderbilt Clinical and Translational Science Award [Grants UL1TR000445 (Dr Pugh), T32 HL087738 (Dr Pugh), and 5 K08 HL093363 (Dr Hemnes)].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):159-166. doi:10.1378/chest.13-1900
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BACKGROUND:  Pulmonary hypertension (PH) is common in elderly patients, but a detailed analysis of the causes of PH in the elderly has not been performed. We hypothesized that pulmonary arterial hypertension (PAH) is rare in elderly patients and sought to describe the characteristics of these patients at a large referral center.

METHODS:  Clinical and hemodynamic data were collected on consecutive patients ≥ 65 years of age referred for evaluation of PH. The subtype of PH was determined after standard evaluation using the World Health Organization (WHO) classification. Patients with PH not meeting criteria for PAH with “out-of-proportion” PH related to group 2 or group 3 disease were classified as “other/mixed PH.” A model using age, presence of connective tissue disease, and left atrial size was developed to predict the probability of PAH diagnosis.

RESULTS:  Two hundred forty-six elderly patients were evaluated (mean age, 72.9 ± 5.5 years, 78% women); 36 had PAH (15%). Idiopathic PAH was rare (four patients, 1.6%). WHO group 2 PH was the most frequent diagnosis (n = 70, 28% of cohort); mixed/other PH (n = 43, 17%) and WHO group 3 PH (n = 34, 14%) were also common diagnoses. Connective tissue disease strongly predicted PAH diagnosis (OR, 27.2; 95% CI, 9.5-77.6).

CONCLUSIONS:  PAH is an uncommon cause of PH in elderly patients, most frequently associated with connective tissue disease. WHO group 2 PH and mixed disease are common, highlighting a need for careful phenotyping of elderly patients with PH prior to initiating PAH therapy.

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