Pulmonary Arterial Hypertension Mild, Moderate, Severe Classification

Written by Xie Zhi Hong
Cardiology
Updated on March 19, 2025
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Pulmonary artery pressure refers to the average pressure in the pulmonary artery when the body is at rest. Generally, the normal average pulmonary artery pressure is less than 25mmHg. Pulmonary hypertension is considered when the pulmonary artery pressure exceeds 25mmHg. The grading is generally divided into three levels based on the data: the first level is mild pulmonary hypertension with pulmonary artery pressure between 26-35mmHg; moderate with pressure between 36-45mmHg; and severe with pressure greater than 45mmHg. If classified by the functional impact of pulmonary hypertension, grade I pulmonary hypertension is characterized by patients who are not limited in daily activities, and do not experience symptoms such as shortness of breath, difficulty breathing, or chest tightness after physical activity. Grade II pulmonary hypertension patients are limited by mild activities, do not feel discomfort at rest, but experience symptoms like difficulty breathing, fatigue, chest tightness, and chest pain during everyday activities. Grade III pulmonary hypertension patients have significantly limited activity; they feel no discomfort at rest, but experience symptoms like difficulty breathing, fatigue, and chest pain after only mild activity, less than everyday activities. Grade IV pulmonary hypertension is severe, with patients experiencing symptoms such as difficulty breathing and feeling tightness in their chest even at rest without any activity.

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Written by Li Hai Wen
Cardiology
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Obvious symptoms of pulmonary hypertension

Pulmonary hypertension is a relatively common disease in everyday life. Based on the causes of pulmonary hypertension, it can be divided into two categories: primary and secondary pulmonary hypertension. Regardless of the type of pulmonary hypertension, patients often exhibit certain symptoms, such as chest tightness and shortness of breath, which are the most common symptoms. In severe cases, some patients may even experience syncope. When pulmonary hypertension affects the heart, causing right ventricular enlargement, patients often show signs of right heart failure, such as shortness of breath, difficulty breathing, lower limb edema, and gastrointestinal symptoms, such as nausea and abdominal distension.

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Written by Zeng Wei Jie
Cardiology
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How to treat pulmonary hypertension?

Pulmonary arterial hypertension (PAH), depending on its various causes, has different treatments. The treatment commonly referred to as for pulmonary arterial hypertension specifically targets Group 1 PAH. This category of PAH has some targeted medications that are quite effective, such as prostacyclin medications, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. These drugs target pulmonary artery pressure among other things. In addition to targeted treatments, anticoagulant therapy is usually necessary. When right heart failure occurs, diuretic therapy may be needed. In advanced stages, heart-lung or lung transplantation might be required.

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Written by Tang Li
Cardiology
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How to diagnose pulmonary arterial hypertension?

To accurately diagnose pulmonary hypertension, the following aspects should be considered: symptoms, signs, laboratory, and other tests. Early-stage pulmonary hypertension usually doesn't exhibit clear symptoms, but discomfort occurs during intense activities. Common symptoms include difficulty breathing, chest pain, dizziness or fainting, and coughing up blood. Additionally, patients should undergo laboratory tests such as blood tests including liver function tests and HIV antibody testing, serological tests; an electrocardiogram to check for right ventricular enlargement or hypertrophy; chest X-ray; echocardiography and Doppler ultrasound; pulmonary function tests; blood gas analysis; radioactive isotope lung ventilation/perfusion scan; right heart catheterization; and lung biopsy.

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Written by Yuan Qing
Pulmonology
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Does pulmonary hypertension require oxygen therapy?

Whether pulmonary arterial hypertension requires oxygen therapy primarily depends on the patient's blood oxygen saturation level at rest. Generally, it is recommended to measure the oxygen saturation for patients with pulmonary arterial hypertension. Due to intrapulmonary shunting and shunting between the left and right heart during pulmonary arterial hypertension, arterial and venous blood mix directly, resulting in very low blood oxygen saturation in patients. Generally speaking, if the measured blood oxygen saturation at rest is below 90%, such patients often need oxygen therapy. Even if it does not drop below 90%, patients with moderate to severe pulmonary arterial hypertension also require oxygen therapy. Oxygen therapy can improve hypoxia, significantly dilating the pulmonary vessels and thus alleviating symptoms of high pulmonary artery pressure. It is very valuable for improving patient prognosis and survival time.

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Written by Zeng Wei Jie
Cardiology
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How is pulmonary hypertension measured?

There are usually two methods to measure pulmonary arterial hypertension. One is through echocardiography to estimate, by measuring the speed of tricuspid regurgitation and then calculating the systolic pressure of the pulmonary artery through a formula. This method may overestimate or underestimate, hence its accuracy is not reliable. The gold standard is measuring pulmonary artery pressure via right heart catheterization. The downside of this gold standard is that it is an invasive procedure, which needs to be performed in a catheterization room; compared to ultrasound, it is also more costly. These are the two methods, each with its pros and cons. We need to choose based on the patient's situation.