Actualización en el diagnóstico, tratamiento y pronóstico de la hipertensión pulmonar

Abstract

Introduction: Pulmonary hypertension is an acute or chronic syndrome of multifactorial causes that affects pulmonary arterial pressures with cardiac repercussions of high morbidity and mortality. With technological and diagnostic advances, it has become a relatively frequent pathology; however, in developing countries it continues to be diagnosed late due to high costs and poor access to specific diagnosis and treatment, remaining a rare syndrome with poor short-term prognosis without timely treatment, which causes a public health problem. The current medical situation seeks greater diagnostic objectivity to adequately classify the pathology, as well as specific treatments to slow down clinical deterioration and increase survival time. Objective: To systematize new updates on the diagnosis, treatment and prognosis of pulmonary hypertension. Methods: A descriptive and retrospective bibliographic review of documents published by scientific societies detailing updates on the diagnosis, treatment and prognosis of pulmonary hypertension was carried out. Bibliographic documents published in the last 5 years, from 2018 onwards were located through various documentary sources such as relevant scientific articles, clinical practice guidelines, systematic reviews and meta-analyses of high scientific relevance in both English and Spanish language pages, in different databases such as: Dialnet, Pubmed, Scielo, The New England Journal of Medicine, Medline, Mediagraphic, Science Direct and Oxford Academic. Results: Pulmonary hypertension has a prevalence in the world population of 1%, which increases to 10% in people over 65 years of age. More than 80% live in developing countries. In Ecuador, 7 per million inhabitants present the pathology. The average time between the onset of symptoms and diagnosis is 2 years. A meta-analysis showed a 38% decrease in the risk of clinical deterioration in favor of combination therapy versus monotherapy; however, the risk reduction was of non-fatal events but not of mortality. Conclusions: Overall and despite the advent of technological medical development, pulmonary hypertension continues to be classified as a rare pathology, with poor clinical evolution and poor prognosis. Left heart pathologies are the most frequent cause. Early diagnosis is the fundamental pillar that modifies the prognosis of the disease, increasing survival rates. Combined oral therapy has proven to be the most effective therapy compared to monotherapy. The elaboration and updating of diagnostic and therapeutic protocols have allowed a better management of the pathology in developed countries, establishing a guiding model for developing countries seeking to draw up practical clinical guidelines to be implemented in their population.