CHEST updates guidelines on therapy for pulmonary arterial hypertension

The American College of Chest Physicians^® (CHEST) announced the publication of updates to the evidence-based guidelines on therapy for pulmonary arterial hypertension (PAH). PAH is a progressive disease that affects the small arteries in the lungs, which can lead to right-sided heart failure and death. There is no cure for PAH; there are several medications approved for the treatment of the disease. In the latest evidence-based guideline, Therapy for Pulmonary Arterial Hypertension in Adults: Update of the CHEST Guideline and Expert Panel Report, experts provide 78 evidence-based recommendations for appropriate use in treating patients with PAH.

"New recommendations and ungraded consensus-based statements were developed in this update based on new studies that were published since the 2014 guidelines. In addition, an evidence-based and consensus-driven treatment algorithm was created to guide the clinician through an organized approach to management," says CHEST Pulmonary Arterial Hypertension Guidelines Committee Co-Chair, Dr. Deborah Jo Levine.

As part of the guideline development process, the panel updated the systematic review on the same clinical questions and criteria. Based on the results of the systematic review, the panel developed two new recommendations about pharmacologic therapy for PAH:

• For treatment-naive patients with PAH who are World Health Organization (WHO) functional class II and III, we suggest initial combination therapy with ambrisentan and tadalafil to improve six-minute walk distance (6MWD).
• For stable or symptomatic patients with PAH on background therapy with ambrisentan, we suggest the addition of tadalafil to improve 6MWD.

The complete guideline article is free to view in the Online First section of the journal CHEST^®.