Pulmonary hypertension (PH) — high blood pressure in the lungs — can’t be treated with standard hypertension drugs. Once a disease with a dismal prognosis, contemporary therapies can now halt and sometimes reverse PH.
“We now have a number of effective treatments for PH. What was once a progressive and incurable disease can now be managed for the majority of patients,” says Terry Fortin, MD, and Co-Director of the Center for Pulmonary Vascular Disease, a Pulmonary Hypertension Association (PHA)-designated Comprehensive Care Center.
Treating and doing research into PH is a collaborative effort among physicians from the Division of Pulmonary, Allergy and Critical Care Medicine and the Division of Cardiology. That’s because PH is a disease of the lungs in which the right ventricle of the heart becomes damaged over time.
With more than a dozen approved therapies, and others being investigated through clinical trials at Duke, outcomes for patients have improved considerably. “Historically, much of the access to medicines for these patients has been through clinical research. We continue to offer a number of trial options to patients,” says Willard Applefeld, MD, a PH physician. “In addition to conducting clinical trials, Duke physicians also conduct basic research into how PH works on a molecular level — which might open the door for future drug therapies,” says Sudarshan Rajagopal, MD, PhD, Co-Director of the Center for Pulmonary Vascular Disease and an active physician-scientist researcher.
Duke is one of the few centers in the United States that performs surgery to treat a particular type of PH called chronic thromboembolic pulmonary hypertension (CTEPH), in which there are undissolved blood clots in the lungs. The surgery, called pulmonary thromboendarterectomy (PTE), can be life-changing for patients who are candidates for it. For those who are not candidates for PTE, other therapeutic options such as balloon pulmonary angioplasty (BPA) and medical therapy can significantly improve their outcomes.
“Having all treatment options available for CTEPH is critical at a comprehensive care center like Duke.” says Divya Verma, MD. As medical director of the CTEPH program, she works closely with Dr. Jacob Schroeder, MD, the program’s Surgical Director, and Mariem Sawan, MD, the program’s BPA Director. She’d like to get the word out to referring physicians from other hospitals who may have CTEPH patients who could benefit from treatment.
Despite the number of available therapeutic options, PH can still progress in some patients. In that situation, referral to lung transplant is critical. “Lung transplant still plays an important role in the treatment of PH patients who continue to have significant limitation despite medical therapy,” says Dr. Brandon Menachem, MD, a PH and lung transplant specialist. “Rarely, some patients may require heart-lung transplantation, an option which is available through our expertise and experience at Duke,” says Dr. Jordan Whitson, MD, a PH and lung transplant specialist.
This experience and access to care makes the Duke PH Comprehensive Care Center a natural choice for the care and co-management of patients across the spectrum of PH.