Resource spotlight: Pulmonary Hypertension

August 12, 2022

 

Written by Jessica Sheard

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca


Background


Pulmonary hypertension (PH) is an uncommon, yet serious and progressive disease that results in significant morbidity and mortality in all patients diagnosed1. This “Resource Spotlight” will provide pharmacists with resources that will help them learn more about pulmonary hypertension, its classifications, and its treatments, and highlights clinical guidelines and information regarding acute management in hospitalized patients. 

Pulmonary Hypertension Association of Canada

The Pulmonary Hypertension Association of Canada is a federally registered charitable organization that was created by patients, caregivers, and healthcare providers. The organization provides useful resources and community support for patients with PH and their caregivers, as well as educational resources for healthcare providers. Pharmacists can find a brief overview of available treatments for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension in Canada 2, and overview of risk factors associated with pulmonary hypertension and signs of symptoms to watch out for in these patients3. When encountering patients with pulmonary hypertension in the hospital, pharmacists may need to provide education and recommendations on their medications, including over the counter (OTC) products. A brief overview of common OTC products that should be avoided in patients with pulmonary hypertension can be found in this resource4.

Canadian Cardiovascular Society and Canadian Thoracic Society Guidelines

The Canadian Cardiovascular Society (CCS) and Canadian Thoracic Society (CTS) released an updated position statement on pulmonary hypertension in 20205. This new position statement was created due to the rapid changes in the management of PH since their previous position statement in 2005. In this document, pharmacists can find guidelines on supportive management, targeted therapies for pulmonary arterial hypertension (PAH) available in Canada, treatment strategies, and information on medication access in Canada. The position statement also contains a map of current pulmonary hypertension treatment facilities for reference. 
The Canadian Cardiovascular Society has developed a webinar6 for healthcare providers to learn about updates in pulmonary hypertension, based on the aforementioned combined position statement from the CCS and CTS. The webinar discusses classification of PH, patient case examples, and management of PH, including general medications, PAH-targeted therapies, and acute management. 

Current Literature

Patients with pulmonary arterial hypertension will often be on one or more targeted therapies to improve their symptoms. An article by Barlow et al, 7 provides an overview of the available targeted therapies that are used chronically in PAH patients, with important clinical considerations of these therapies for when patients are presenting to the emergency department.

Critical care management of the patient with pulmonary hypertension8, published recently in The European Heart Journal provides a great overview of pulmonary hypertension epidemiology, pathophysiology, and a concise overview of patient management in critical care, including PH medication, fluid, and hemodynamic management. 

A concise clinical review 9 by Hoeper and Granton includes important information on the management of patients with severe pulmonary hypertension and right heart failure. In this article, pharmacists can find information on the pathophysiology and classification of PH, triggering factors of PH and RV failure, as well as important management and monitoring considerations for patients admitted to the ICU. Although published in 2011, this article still contains useful clinical guidance in the Canadian context.


References

1. Hirani, N., Brunner, N. W., Kapasi, A., Chandy, G., Rudski, L., Paterson, I., Langleben, D., Mehta, S., & Mielniczuk, L. (2020). Canadian Cardiovascular Society/Canadian Thoracic Society Position Statement on pulmonary hypertension. Canadian Journal of Cardiology, 36(7), 977–992. https://doi.org/10.1016/j.cjca.2019.11.041

2. Treatment Options. Pulmonary Hypertension Association of Canada. 2021. Retrieved June 23, 2022, from https://phacanada.ca/For-Physicians/Treatment-Options 

3. Sometimes It’s PH. Pulmonary Hypertension Association of Canada. 2021. Retrieved June 23, 2022, from https://phacanada.ca/For-Physicians/Sometimes-It-s-PH

4. Managing medications. Resources - Pulmonary Hypertension Association of Canada. Retrieved June 23, 2022, from https://phacanada.ca/Living-with-PH/Resources/Living-with-PH/Managing-medications

5. Hirani, N., Brunner, N. W., Kapasi, A., Chandy, G., Rudski, L., Paterson, I., Langleben, D., Mehta, S., & Mielniczuk, L. (2020). Canadian Cardiovascular Society/Canadian Thoracic Society Position Statement on pulmonary hypertension. Canadian Journal of Cardiology, 36(7), 977–992. https://doi.org/10.1016/j.cjca.2019.11.041 

6. Pulmonary hypertension webinar series. Canadian Cardiovascular Society. https://ccs.ca/pulmonary-hypertension-webinar-series/. Published August 27, 2021. Accessed June 23, 2022.

7. Barlow, A., Barlow, B., Koyfman, A., Long, B., & Bissell, B. 2021. Pulmonary arterial hypertension in the emergency department: A focus on medication management. The American Journal of Emergency Medicine, 47, 101–108. https://doi.org/10.1016/j.ajem.2021.03.072

8. Barnett, C. F., O’Brien, C., & De Marco, T. 2022. Critical Care Management of the patient with pulmonary hypertension. European Heart Journal. Acute Cardiovascular Care, 11(1), 77–83. https://doi.org/10.1093/ehjacc/zuab113 

9. Hoeper, M. M., & Granton, J. 2011. Intensive Care Unit management of patients with severe pulmonary hypertension and right heart failure. American Journal of Respiratory and Critical Care Medicine, 184(10), 1114–1124. https://doi.org/10.1164/rccm.201104-0662ci