At the end of 2013 clinicians managing pulmonary arterial hypertension (PAH) patients have many more treatment options available to them than they did two decades ago. Basic and clinical research continue to expand treatment options but, in a changing PAH environment, there is a need to move away from trials with primary end-points that merely demonstrate short-term improvements in function to large scale trials utilising robust end-points that reflect long-term morbidity and mortality [1].
The reviews in this issue of the European Respiratory Review discuss this evolution of study design and management of patients with PAH. The authors, all experts in the field of pulmonary hypertension, delivered the presentations upon which the articles are based at the 12th International Pulmonary Hypertension Forum in April 2013 in Hamburg, Germany. This annual platform for the exchange of knowledge and experience among clinicians and researchers was attended by over 1000 healthcare professionals from all over the world, highlighting the continuing interest in PAH.
All oral therapies currently available for the management of PAH have been approved based on change in 6-min walk distance (6MWD) over a short 12–16-week study period [2–6]. The 6MWD is a simple, inexpensive, reproducible test that has allowed the rapid expansion of therapeutic options in PAH, and remains a valuable, clinically important measure of symptomatic improvement. However, in today's more advanced PAH field, its utility as a primary end-point has been challenged. In their review, Gaine and Simonneau [7] will discuss the limitations of the 6MWD, including its reduced sensitivity in patients with milder disease [8] and the reduced ability to detect a treatment …
