Pulmonary Hypertension in Hispanics: An Update on Treatment Options and Possible Causes

Abstract

Pulmonary arterial hypertension, a form of pulmonary hypertension (PH), is a rare but serious disease. This condition carries significantly increased risk of morbidity and mortality, associated with progressive elevations of pulmonary pressures and the subsequent development of right heart failure. PAH can also be very difficult to diagnose primarily because the initial symptom of shortness of breath can be very nonspecific and similar to other diseases. There are certain medications used to target obesity that have been associated with the development of pulmonary hypertension. Aminorex, commonly used in Europe in the 1960s, has been grossly tied with PAH. Additionally, Flenfluramine both on its own and used in combination with Phentermine, as appetite-suppressant medications, were associated with Primary Pulmonary Hypertension and valvulopathies. We believe the widespread use of weight loss medications in Latin America remains a risk factor for PH development in the Hispanic population. The NIH and the REVEAL registries in the United States provide the most information for different races/ethnicities in patients with the diagnosis of PAH. Both NIH and the REVEAL registries in the United States show a lower prevalence of PH than the expected prevalence of 11.5% in the Hispanic population. The underdiagnosis of PH in the Hispanic population can be explained by several causes such as lack of awareness of disease, access to healthcare, and tolerance to symptoms. Remarkable efforts in medicine have been made to better treat patients with this condition in the past few years, with the introduction of combination therapy in treatment-naive patients, which has changed the guidelines for treatment of PAH. Furthermore, recent clinical trials have shown promissory results with initiation of dual or even triple therapy instead of a step up approach in therapeutics. However, the majority of these therapies are indicated for PAH and PH related to connective tissue disease and come with a high financial burden to patients, especially minority patients such as Hispanics.