Most of us have heard of or deal with high blood pressure, a condition also known as hypertension. Hypertension, which is high pressure within the arteries of the heart, is common: It affects about one in three adults in the US.
Pulmonary hypertension, which involves high pressure in the arteries of the lungs, is not nearly as common. But when it does strike, it occurs more often in women than in men.
We spoke with Dr. Jeremy Mazurek, from the Penn Pulmonary Hypertension Program, to understand four important facts women should know about pulmonary hypertension.
Four Facts About Pulmonary Hypertension
We spoke with Dr. Jeremy Mazurek
, from the Penn Pulmonary Hypertension Program
, to understand four important facts women should know about pulmonary hypertension.
All About the Hormones
“Why women have pulmonary hypertension more often than men is a very interesting question, and it’s an area of ongoing research here at Penn,” says Dr Mazurek. “The reason may be hormones. Estrogen, the female sex hormone, may predispose women to developing pulmonary hypertension.”
Estrogen might be detrimental to the right ventricle—the heart’s right lower chamber. It also might somehow harm vessels in the heart and lungs that make up the pulmonary system.
The hormone testosterone could also be involved. It can protect people from pulmonary hypertension, but since women have lower levels of testosterone than men, they benefit less from its protective properties.
However, it’s not all bad news. “Women may get pulmonary hypertension more than men, but they also tend to fare better than men when they do have the condition,” says Dr. Mazurek. The science is still out as to the exact reason, and studies on this are ongoing.
Pulmonary hypertension has been shown to put the mother’s life at risk during pregnancy, and while modern medicine has started to mitigate that risk, it’s still significant—some studies have shown the risk of death to be as high as 56%.
There are also risks to the baby, particularly in women with pulmonary arterial hypertension, which is a type of pulmonary hypertension that causes the walls of the arteries in the lungs to become tight and stiff.
It’s important to work closely with your physician to understand your risks and options. Many women choose permanent birth control options, such as tubal ligation, but for those that do become pregnant, there are steps to help mitigate risk.
“We have seen good results working closely with our colleagues in the maternal fetal medicine department who work with women with high risk pregnancies,” says Dr. Mazurek. The key is early referral for evaluation and close monitoring throughout the pregnancy.
“We also use medications to help keep the mother and baby healthy—sildenafil is the mainstay, but we might also consider prostacyclin therapy as outpatient or inpatient, depending on the mother’s condition.”
Mode of delivery is also a consideration. While some physicians believe that Cesarian sections are safest, Dr. Mazurek says that there isn’t one recommendation across the board. “We work with the maternal fetal medicine department and discuss delivery options for each patient individually. We often recommend proceeding with the mode of delivery determined by the obstetrician.”
Treatment at Penn
Pulmonary hypertension doesn’t have a cure, but there are ways to manage your symptoms.
“For all patients—both women and men—we start by looking at the root cause of the pulmonary hypertension. Usually, it’s due to disease on the left side of the heart, but there are many other possible causes, and we need to know the exact cause so we can prescribe the right treatment,” explains Dr. Mazurek.
“We perform and review primary tests—echocardiograms, chest imaging, scans, and catheterization, for example. If we find significant pulmonary hypertension, and the patient is not severely ill, we begin by prescribing oral medications. Often, it’s combination therapy—more than one type of drug.”
In 2014, Penn became one of the first hospitals in the country to become a Pulmonary Hypertension Association-accredited Center of Comprehensive Care, and it is still the only accredited center in the region.
“Being the only accredited center in the region means we can care for all patients with pulmonary hypertension, even those with the most complex cases,” Dr. Mazurek says. “If you are a patient, you’ll get treatment with the most modern pulmonary hypertension therapy available.”
At Penn, physicians and researchers also collaborate regularly. “Ultimately, this increases our knowledge of pulmonary hypertension and improves outcomes for patients,” Dr. Mazurek says.
Research at Penn
Penn is currently conducting 11 studies on pulmonary hypertension: six clinical trials and five registry studies.
In one study, researchers are observing women who have pulmonary arterial hypertension and are experiencing a cluster of other symptoms (shortness of breath, fatigue, and insomnia). They are looking to see if the pulmonary arterial hypertension is the cause of these symptoms.
In another, researchers are studying the effects of a drug called fulvestrant. Fulvestrant blocks estrogen receptors, blocking the effects of estrogen, and potentially improving heart and lung function.
Fulvestrant and anastrozole (a drug that also blocks estrogen receptors) are frequently used to treat breast cancer. If they can protect women against pulmonary hypertension, they will have another home in women’s healthcare.
Pulmonary hypertension is a serious condition that uniquely effects women, but here at Penn we are on the leading edge of research and treatment that can help you live your life comfortable.
If you or a loved one has questions about pulmonary hypertension, you can learn more here.