Pulmonary Arterial Pressure during Rest and Exercise (from Geneva, 1961 to Dana Point, 2008)

REVIEW ARTICLE

Gabor Kovacs and Horst Olschewski

Affiliation: Medical University of Graz, Division of Pulmonology, Graz, Austria


ABSTRACT

The first hemodynamic definition of pulmonary hypertension was introduced at a World Health Organization (WHO) meeting on Primary Pulmonary Hypertension in Geneva in 1973. Pulmonary hypertension was defined as mean pulmonary arterial pressure (mPAP) >25 mmHg at rest or >30 mmHg during exercise. This hemodynamic definition was broadly used by clinicians and researchers, and was adopted at upcoming world conferences in Evian 1998 and Venice 2003. At the last world conference in Dana Point in 2008, however, the hemodynamic definition was discussed again. According to the published literature, based on invasive measurements in healthy individuals, resting mPAP is 14.0±3.3 mmHg, is virtually independent of gender and geographical origin, and is only mildly influenced by posture and age. During exercise, however, mPAP is dependent on exercise level and age. The Dana Point statement defines the normal range of resting mPAP between 8 and 20 mmHg and pulmonary hypertension as resting mPAP >25 mmHg. As it may not be possible to define a single upper limit of normal mPAP fitting to all individuals and all exercise levels, the exercise part of the old definition of pulmonary hypertension was abandoned. Further studies are warranted to better determine the natural history of patients with mPAP between 20 and 25 mmHg and an out-of-proportion increase in mPAP during exercise.

Keywords: pulmonary hypertension, pulmonary arterial pressure, exercise, hemodynamic definition, normal

Correspondence: Gabor Kovacs, Medical University of Graz, Division of Pulmonology, Auenbruggerplatz 20, 8036 Graz, Austria. e-mail: gabor.kovacs@klinikum-graz.at