Pulmonary hypertension (PH) occurs commonly in patients with left heart disease, and is associated with increased morbidity and mortality. The pathophysiologic mechanisms of PH in left heart disease are complex, and are thought to be a composite of both passive and active components. PH that is disproportionate to the underlying left heart disease may be attributable to reactive pulmonary vascular remodelling. Management of these patients is focused upon treatment of the underlying left heart disease and its associated comorbidities. There is no supporting evidence for the routine use of specific PH therapies in these patients at present. However, there is some suggestion that PDE-5 inhibitors may be useful, but their safety and efficacy needs to be formally evaluated in controlled trials before further recommendations are made.
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