Pulmonary hypertension: symptoms, causes and treatment
What high blood pressure in the lungs means, its many causes, the breathlessness to take seriously, how it is confirmed, treatment and doctors to see.
Also known as: Cor Pulmonale; Hypertension, Pulmonary; Primary Pulmonary Hypertension; Pulmonary Arterial Hypertension
What pulmonary hypertension is
Pulmonary hypertension is high blood pressure in the arteries of the lungs. It is different from the ordinary high blood pressure measured with a cuff on your arm. The right side of the heart pumps blood through the lungs to pick up oxygen. When the lung arteries become narrowed, stiff or blocked, the pressure inside them rises and the right side of the heart has to work much harder.
Over time the right side of the heart can thicken, enlarge and eventually fail, a condition called cor pulmonale or right heart failure. Pulmonary hypertension is a serious condition that usually gets worse over time, but treatment can relieve symptoms, slow its progress and, for some forms, make a large difference to how long and how well people live. Early diagnosis matters.
Symptoms
Symptoms develop gradually and are easily put down to being unfit, overweight or getting older, which often delays diagnosis:
- Breathlessness, at first during exercise or climbing stairs and later even at rest
- Tiredness and weakness
- Chest pain or pressure, especially on exertion
- Dizziness or fainting during activity
- A racing or pounding heartbeat
- Swollen ankles, legs or abdomen as fluid builds up
- A bluish tinge to the lips or skin in advanced disease
Causes and risk factors
Pulmonary hypertension has many causes, and doctors group them because the cause decides the treatment:
- Left-sided heart disease — the commonest cause overall, including heart failure and diseased heart valves, such as narrowed valves after rheumatic heart disease
- Lung disease and low oxygen — COPD and emphysema, lung scarring, sleep apnoea, living at high altitude, and lung damage after tuberculosis
- Blood clots in the lungs — clots that have not dissolved after a pulmonary embolism can block the arteries, a form called chronic thromboembolic pulmonary hypertension
- Pulmonary arterial hypertension (PAH) — disease of the small lung arteries themselves. It can be inherited, occur without a known cause, or be linked to connective tissue diseases such as scleroderma and lupus, some heart defects present from birth, HIV, liver disease and certain drugs
- Other conditions — including some blood disorders such as sickle cell disease and thalassaemia, and some kidney and metabolic diseases
Pulmonary hypertension can affect people of any age. PAH is more common in women, often starting in young adulthood. In India, doctors also look for rheumatic heart valve disease and lung damage from past tuberculosis, both of which can lead to it.
How it is diagnosed
Because its symptoms are common to many illnesses, pulmonary hypertension is often only found after other conditions have been ruled out. The doctor will examine you and may hear particular heart sounds. Tests include:
- Echocardiogram — an ultrasound of the heart, the main screening test; it estimates the pressure in the lungs and shows how the right side of the heart is coping
- Right heart catheterisation — a thin tube passed through a vein into the right side of the heart to measure the pressures directly; this confirms the diagnosis and guides treatment
- ECG and chest X-ray to look for strain on the heart and lung disease
- Lung function tests and blood oxygen tests to look for lung disease
- CT scan of the chest and a lung ventilation-perfusion scan to look for lung disease and old blood clots
- Blood tests for liver disease, HIV, autoimmune disease and markers of heart strain, a sleep study, and a walking test to measure exercise capacity
Treatment
Treating the underlying cause is the first step: managing heart failure, repairing or replacing diseased valves, treating lung disease and sleep apnoea, and correcting low oxygen. For people with old clots in the lungs, blood thinners are used, and a specialised operation to remove the clots, or a balloon procedure on the lung arteries, may help selected patients.
Supportive treatment includes oxygen therapy for people with low oxygen levels, diuretics (water tablets) to reduce fluid build-up and swelling, and in some cases blood thinners or medicines to support the heart.
For pulmonary arterial hypertension, specialists use pulmonary vasodilator medicines, which relax and widen the lung arteries. They come as tablets, inhalers or continuous infusions, and are often combined. These medicines need specialist supervision and regular monitoring. For severe disease that does not respond to treatment, a lung transplant, or a heart-lung transplant, may be considered at a specialist centre.
Living with pulmonary hypertension
- Stay active within the limits your doctor advises; supervised exercise or rehabilitation can improve stamina, but avoid heavy lifting and straining
- Weigh yourself regularly and report sudden weight gain or more swelling, which can mean fluid is building up
- Follow advice on salt and fluid intake if you have swelling
- Get vaccinated against flu and pneumococcal infection, as chest infections can make you much worse
- Avoid smoking and high altitudes; ask your doctor before air travel, as you may need oxygen on the flight
- Pregnancy can be very dangerous with pulmonary hypertension; discuss contraception and family planning with your specialist
- Check with your doctor before taking any new medicine, including decongestants and herbal products
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, if you have:
- Fainting or near-fainting, especially during activity
- Chest pain that does not settle with rest
- Severe or suddenly worsening breathlessness
- Coughing up blood
- Blue lips or confusion
Which doctor to see
Unexplained breathlessness is usually first investigated by a general physician or an internal medicine specialist. Pulmonary hypertension is managed by a pulmonologist or a cardiologist, often working together, and ideally at a centre with experience in the condition. Right heart catheterisation and treatment for PAH are usually done at larger hospitals.
You can find pulmonologists in Bengaluru or cardiologists in Bengaluru on The Doctor Index, each with a registration you can check.
Common questions
Questions people ask
- Is pulmonary hypertension the same as high blood pressure?
- No. Ordinary high blood pressure affects the arteries throughout the body and is measured with an arm cuff. Pulmonary hypertension affects only the arteries in the lungs and cannot be measured with a cuff; it needs an echocardiogram or right heart catheterisation.
- Can pulmonary hypertension be treated?
- Yes. There is no simple fix for most forms, but treatment can improve symptoms, exercise capacity and outlook. When it is caused by heart or lung disease, treating that condition helps. Some people with old blood clots in the lungs can benefit greatly from specialised surgery or procedures.
- Why do I need a heart catheter test when the echo already shows high pressure?
- An echocardiogram estimates the pressure, but it can over- or underestimate it. Right heart catheterisation measures the pressures directly, confirms the diagnosis, helps identify the type and shows how the lung arteries respond to medicines, which guides treatment choices.
- Can I exercise with pulmonary hypertension?
- Gentle, regular activity is usually encouraged and can improve stamina and wellbeing. Avoid heavy lifting, straining and strenuous exercise that makes you very breathless or dizzy. Ask your specialist about a supervised rehabilitation programme suited to your condition.
This condition is usually assessed by a pulmonologist. Every profile shows the doctor’s registration and what has been checked.
Pulmonologists in Bangalore
A few pulmonologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Pulmonary Hypertension; ask the clinic whether the doctor sees it.
Related conditions
- Acute Bronchitis
- Asthma
- Chronic Bronchitis
- COPD
- Emphysema
- Pulmonary Embolism
- Pulmonary Fibrosis
- Sleep Apnea
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Pulmonary Hypertension
- Government of India — Emergency Response Support System (112)
- MedlinePlus, National Library of Medicine — Pulmonary Hypertension — Public-domain health-topic summary
Pulmonary hypertension: symptoms, causes and treatment is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1989.