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Pulmonary hypertension — high blood pressure in the pulmonary (lung) arteries — is one of the complications of COPD. What do you need to know about its symptoms, diagnosis, and treatment?

Pulmonary hypertension — high blood pressure in the pulmonary (lung) arteries — hardens and narrows the blood vessels that get blood to and from your lungs, in turn increasing your risk of heart failure. It can strike for unknown reasons or be related to genetics, but pulmonary hypertension can also emerge as a complication of chronic obstructive pulmonary disease. 

COPD patients who also have pulmonary hypertension are more likely to suffer from serious COPD flare-ups, worsening your prognosis even though the pulmonary hypertension COPD patients suffer from usually develops only slowly and isn't typically very severe. Pulmonary hypertension additionally affects your heart health, frequently compromising the right side that has the task of supplying your lungs. When the heart muscle has to "work overtime" to get blood to and from your lungs, it grows and becomes weaker over time. This state, called "cor pulmonale", is thought to afflict around six percent of people living with COPD annually. 

What should everyone diagnosed with COPD know about pulmonary hypertension? Let's take a deeper look!

Symptoms: Are there any obvious signs that you may have pulmonary hypertension?

As with so many conditions that can co-exist with COPD, some of the symptoms of pulmonary hypertension resemble those of COPD — making it harder for patients to notice that something new is wrong. These symptoms include shortness of breath, of course, and the fatigue that is more common in the later stages of COPD. 

Symptoms of pulmonary hypertension not typically associated with COPD — and symptoms that can signify that your heart health is in grave danger as well — include:

  • Periods during which you feel dizzy or actually faint. An irregular heartbeat (arrhythmia).
  • Chest pain or chest tightness. 
  • Edema, a build-up of excess fluids that leads to swelling. This often occurs in the ankles, legs, and the abdomen.
  • Cyanosis, a phenomenon in which your skin and mucus membranes take on a blue tint because of a lack of oxygen. 

All of these symptoms are most likely to strike, or reach a peak, when you are engaged in strenuous physical activities like exercise.

How is pulmonary hypertension diagnosed if you already have COPD?

Because the symptoms patients manifest with mimic those of other heart- and lung-related health conditions, you should expect a thorough diagnostic process. Your doctor will not just be looking to rule pulmonary hypertension in or out, but will also evaluate you for other problems.

The tests your doctor is likely to order include:

  • En echocardiogram to determine how well your heart is functioning, as well as to broadly assess the blood pressure in your pulmonary arteries. It can also reveal congenital abnormalities. 
  • An electrocardiogram or ECG measures the electrical activity of your heart, and is used to determine its rhythm and to get a closer look at its functioning.
  • A lung CT scan. 
  • Blood tests. 
  • A V/Q scan to search for blood clots. 
  • A spirometry, which you'll already be familiar with as a COPD patient. 
  • A sleep study to assess your oxygen levels during sleep.
  • A right heart catheterization (or pulmonary artery catheterization) is used to definitively diagnosed pulmonary hypertension, as it assesses the blood pressure in your pulmonary arteries and the right portion of your heart. During this procedure, a tube (the catheter) will be inserted. Patients are conscious but numbed, and you may require short hospital stay. 

How pulmonary hypertension treated in COPD patients?

In pulmonary hypertension that directly resulted from COPD, the primary focus of treatment is managing the COPD itself in the best possible way. Since your pulmonary hypertension is a secondary problem with a clear cause, well-managed COPD will lower your pulmonary pressure as well, and you probably won't be offered pulmonary vasodilators like people with essential pulmonary hypertension. 

If your pulmonary hypertension wasn't caused by COPD, you can expect vasodilators, which relax the arteries so they can work better, thereby also relieving the heart. These medications can include phosphodiesterase 5 (PDE5) inhibitors, soluble guanylate cyclase stimulators (SGCSs), ​endothelin receptor antagonists, and prostaglandins.

Other medications that can be part of the treatment plan for pulmonary hypertension include: 

  • Diuretics.
  • Supplemental oxygen.
  • Anticoagulants.
  • Pulmonary rehabilitation, also often offered to COPD patients. 

In addition, you should get your annual flu shot, stay up to date on pneumococal vaccination, steer clear of high altitudes (anything above 1500 to 2000 m), and may well benefit from supplemental oxygen if you travel by air.

How will pulmonary hypertension affect your future when you already have COPD?

People who suffer from both COPD and pulmonary hypertension have a higher risk of heart failure, kidney disease, edema, and some other complications — so it is important that you receive proper medical care. However, COPD-related pulmonary hypertension typically progresses at a slow rate, and your pulmonary blood pressure will often stay fairly consistent for a period of up to 10 years. 

  • Chaouat, A., Naeije, R., & Weitzenblum, E. (2008). Pulmonary hypertension in COPD. European Respiratory Journal, 32(5), 1371–1385.
  • Barberà, J. A., Peinado, V. I., & Santos, S. (2003). Pulmonary hypertension in chronic obstructive pulmonary disease. European Respiratory Journal, 21(5), 892–905.
  • Wright, J. L. (2005). Pulmonary hypertension in chronic obstructive pulmonary disease: current theories of pathogenesis and their implications for treatment. Thorax, 60(7), 605–609.
  • Photo courtesy of SteadyHealth

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