Pulmonary hypertension in low- and middle-income countries with focus on sub-Saharan Africa

Abstract

Pulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy. This article reviews the global epidemiology of PH with focus on low-and middle-income countries (LMICs) and sub-Sahara African in particular. Although left ventricular heart disease is the most common cause globally, the main contributing risk factors in LMICs are chronic infectious diseases especially human immunodeficiency virus (HIV) and schistosomiasis. Other important risk factors of PH are rheumatic heart disease, untreated congenital heart disease (CHD), and sickle cell disease. Despite existing epidemiological data of PH risk factors suggesting a high prevalence in sub-Saharan Africa (SSA), the available literature is limited. International registries in LMICs like the pan African pulmonary hypertension cohort (PAPUCO) study are essential to provide information about the causes, treatment, outcome, and the natural course of PH in Africa and other parts of the world. In addition,there is a need to track diagnostic and management practices in order to develop suitable algorithms to diagnose PH in LMICs.

Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders

“…Since most high altitude populations live in resource-limited countries, access to the currently approved pulmonary arterial hypertension pharmacologic therapies may be limited by their availability and their cost [ 320 , 321 ]. Therefore, discovery of inexpensive treatment strategies by repurposing drugs that are already used for other medical conditions might represent another attractive option [ 322 , 323 ].…”

Correlation of echocardiographic probability of pulmonary hypertension with maternal outcomes in pregnant women with elevated right ventricular systolic pressure

“…1 However, similar to the general population, the majority of patients had structural heart disease or clinical features consistent with PH due to left heart disease. 4,10 Further noninvasive methods of classifying PH subgroups have been described 16,17 and could potentially be applied to pregnant women with elevated RVSP to help determine the need for invasive hemodynamic assessment.…”

What’s new in pulmonary hypertension clinical research: lessons from the best abstracts at the 2020 American Thoracic Society International Conference

“…For example, a forward-thinking section gave recommendations on management issues encountered in middle and low-income regions. It is acknowledged that current guidelines for adult PH are not practical in these regions, 145 but no tailored consensus recommendations have been provided. The EPPVDN’s systematic approach most importantly identified knowledge gaps and clinical research priorities that will likely fuel advancements in the field ( Table 4 ).…”