A Treatment Algorithm for Pulmonary Arterial Hypertension

Nazzareno Galiè, MD Department of Experimental, Diagnostic and Specialty Medicine-DIMES Bologna University Hospital Bologna, Italy The treatment algorithm for pulmonary arterial hypertension (PAH) represents graphically a sequence of operations that are needed for the management of patients. The treatment algorithm includes different types of recommendations with varying degrees of scientific evidence. The recommendations are based on information derived from different areas including clinical, hemodynamic, medical, interventional, pharmacological, and regulatory domains. The current treatment algorithm is divided into 3 main sections: I) general measures, supportive therapy, referral strategy, acute vasoreactivity testing, and chronic treatment with calcium channel blockers; II) initial therapy with approved PAH drugs; III) clinical response to the initial therapy, combination therapy, balloon atrial septostomy, and lung transplantation. The European Society of Cardiology grades of recommendation and levels of evidence are adopted to rank the proposed treatments.