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

Main Article Content

Rafael Miret, DO Ana Martinez-Nunez, MD Mari Tesh Zeeshan Chauhan, MD Mauricio Danckers, MD Marcos Sanchez-Gonzalez, MD Gustavo Ferrer, MD


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.

Article Details

How to Cite
MIRET, Rafael et al. Pulmonary Hypertension in Hispanics: An Update on Treatment Options and Possible Causes. Medical Research Archives, [S.l.], v. 10, n. 11, nov. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3302>. Date accessed: 29 mar. 2023. doi: https://doi.org/10.18103/mra.v10i11.3302.
Research Articles


1- Simonneau, Gérald, et al. "Haemodynamic definitions and updated clinical classification of pulmonary hypertension." European Respiratory Journal 53.1 (2019).

2- Prins, Kurt W., and Thenappan Thenappan. "World Health Organization Group I pulmonary hypertension: epidemiology and pathophysiology." Cardiology clinics 34.3 (2016): 363-374.

3- Frost, Adaani E., et al. "The changing picture of patients with pulmonary arterial hypertension in the United States: how REVEAL differs from historic and non-US Contemporary Registries." Chest 139.1 (2011): 128-137.

4- Vachiéry, Jean-Luc, et al. "Pulmonary hypertension due to left heart disease." European respiratory journal 53.1 (2019).

5- Packer, Milton, et al. "Long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure: primary results of the ENABLE trials." JACC: Heart Failure 5.5 (2017): 317-326.

6- Bermejo, Javier, et al. "Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial." European Heart Journal 39.15 (2018): 1255-1264.

7- Nathan, Steven D., et al. "Pulmonary hypertension in chronic lung disease and hypoxia." European Respiratory Journal 53.1 (2019).

8 -Chaouat, Ari, Robert Naeije, and E. Weitzenblum. "Pulmonary hypertension in COPD." European Respiratory Journal 32.5 (2008): 1371-1385.

9- Eddahibi, S., et al. "Attenuated hypoxic pulmonary hypertension in mice lacking the 5-hydroxytryptamine transporter gene." The Journal of clinical investigation 105.11 (2000): 1555-1562.

10- Kim, Nick H. "Group 4 pulmonary hypertension: chronic thromboembolic pulmonary hypertension: epidemiology, pathophysiology, and treatment." Cardiology Clinics 34.3 (2016): 435-441.

11- Gopalan, Deepa, Marion Delcroix, and Matthias Held. "Diagnosis of chronic thromboembolic pulmonary hypertension." European Respiratory Review 26.143 (2017).

12- Ley, Sebastian, et al. "Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH)." European radiology 22.3 (2012): 607-616.

13- Pepke-Zaba, Joanna, Hossein-Ardeschir Ghofrani, and Marius M. Hoeper. "Medical management of chronic thromboembolic pulmonary hypertension." European Respiratory Review 26.143 (2017).

14- Cannon, John E., et al. "Dynamic risk stratification of patient long-term outcome after pulmonary endarterectomy: results from the United Kingdom National Cohort." Circulation 133.18 (2016): 1761-1771.

15- Ghofrani, Hossein-Ardeschir, et al. "Riociguat for the treatment of chronic thromboembolic pulmonary hypertension." New England Journal of Medicine 369.4 (2013): 319-329.

16- Kalantari, Sara, and Mardi Gomberg-Maitland. "Group 5 pulmonary hypertension: the orphan’s orphan disease." Cardiology clinics 34.3 (2016): 443-449.

17- Diaz, Raiko, and Gustavo Ferrer. "Pulmonary Arterial Hypertension in Hispanics." Cureus 11.10 (2019).

18- Kim, Kyung Won, et al. "Association between cystic fibrosis transmembrane conductance regulator gene mutations and susceptibility for childhood asthma in Korea." Yonsei Medical Journal 51.6 (2010): 912-917.

19- Shah, Trushil G., Sonja D. Bartolome, and Kelly M. Chin. "Anorexigen-Associated Pulmonary Arterial Hypertension and the Serotonin Hypothesis: A Story Worth Telling." Advances in Pulmonary Hypertension 17.2 (2018): 63-68.

20- Tsai, Halley, Yon K. Sung, and Vinicio de Jesus Perez. "Recent advances in the management of pulmonary arterial hypertension." F1000Research 5 (2016).

21-Hong, Zhigang, et al. "Nordexfenfluramine causes more severe pulmonary vasoconstriction than dexfenfluramine." American Journal of Physiology-Lung Cellular and Molecular Physiology 286.3 (2004): L531-L538.

22- Vitagliano, Julia A., et al. "Disproportionate Use of Over-the-counter Diet Pills Among Latinx Youth and Increased Use Over Time Among Latinx Females: Results of US National Study." Journal of Adolescent Health 70.6 (2022): 993-996.

23- Valverde, Ana Beatriz, et al. "Pulmonary arterial hypertension in Latin America: epidemiological data from local studies." BMC pulmonary medicine 18.1 (2018): 1-8.

24- Lopes, Antonio Augusto, et al. "Pulmonary hypertension in Latin America: pulmonary vascular disease: the global perspective." Chest 137.6 (2010): 78S-84S.

25- Escarce, José J., and Kanika Kapur. Access to and quality of health care. Vol. 2006. Washington, DC: National Academies Press, 2006.

26- Alves Jr, Jose Leonidas, et al. "Pulmonary arterial hypertension in the southern hemisphere." Chest 147.2 (2015): 495-501.

27- Khatab, Yacoub, et al. "The Association of N-Terminal Pro-Brain Natriuretic Peptide With Time to Clinical Worsening in Hispanic Patients With Pulmonary Arterial Hypertension." Cardiology Research 13.2 (2022): 73.

28- Transplantat, Int Soc Heart Lung, et al. "2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG)." European Heart Journal (2022): ehac237.