Pulmonary hypertension in the elderly. Is it an overdiagnosis or a distinct entity?

N. Öcal, M. Çelik, N.K. Satış

Department of Pulmonology, Gulhane Medical Faculty, Health Sciences University, Ankara, Turkey. nesrinbaygin@yahoo.com

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• Respiratory Medicine

OBJECTIVE: The diagnosis of pulmonary hypertension (PH) in the elderly has become more common, recently. The possibility of overdiagnosis or misdiagnosis may arise in the elderly due to accompanying physiological changes and comorbidities. In this study, we aimed at revealing the clinical findings of individuals aged 60 years and older who were diagnosed with Group 1 and Group 4 PH, and at determining their differences with younger adults.

PATIENTS AND METHODS: Patients aged 60 years and older who were diagnosed with PH were identified. Among these patients, patients with a diagnosis of Group 1 PH (PAH) and Group 4 PH (CTEPH) were selected. A control group was formed from young and middle-aged patients. Demographic, clinical and hemadynamic characteristics of the elderly patients and the control group were analyzed.

RESULTS: The mean WHO Functional Class and the Charlson Comorbidity Index score were significantly higher; the mean EF was significantly lower in the elderly. The right heart catheterization results were assessed. While the mean PAP was significantly higher in young-middle-aged patients (49.6 vs. 39.2 mmHg) (p=0.03), the mean PCWB was significantly higher in the elderly (11.4 vs. 8.1 mmHg) (p=0.005). The young-middle-aged patients had a significantly higher mean PVR values (10.7 vs. 8.3 WU) (p=0.01).

CONCLUSIONS: Comorbidities and age-related functional losses may complicate the diagnosis of PH in elderly. Group 2 PH, which we frequently encounter in the elderly, may mask the true Group 1 or Group 4 PH in these patients. PH should be kept in mind in the elderly patients with unexplained exertional dyspnea.

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