Service de Pneumologie, Programme Hypertension Pulmonaire, Hôpitaux Universitaires de Genève, Suisse.
Semin Respir Crit Care Med. 2013 Oct;34(5):654-64. doi: 10.1055/s-0033-1356549. Epub 2013 Sep 13.
Recent reports from pulmonary arterial hypertension (PAH) registries suggest that the mean age at diagnosis is increasing, outlining a growing proportion of elderly male patients. As a consequence, the classical description of the disease is shifting and may no more be described as a rare disease typically affecting young women. Potential explanations of this changing picture may include an aging of populations in western countries, the increase in life expectancy and the growing awareness of PAH and emergence of potential efficient treatments. Diagnostic workup of severe pulmonary hypertension (PH) in the elderly should be performed in such a way as to discriminate between the expected consequences of aging, pulmonary vascular disease, and other frequent causes of secondary PH (left heart failure or lung disease). Careful exploration by right heart catheterization is mandatory, but special attention should be paid to several pitfalls specific to this procedure in this age group. This is a matter of concern as clinical trials that aim to study new specific drug therapy for PAH might be biased by the inclusion of misdiagnosed patients. The aim of this review is to highlight the main difficulties in diagnosing PAH in the elderly and to propose a practical approach to distinguish PAH from the other frequent causes of PH in this population.
最近来自肺动脉高压（PAH）登记处的报告表明，诊断时的平均年龄正在增加，老年男性患者的比例也在不断增加。因此，疾病的经典描述正在发生变化，可能不再被描述为一种常见于年轻女性的罕见疾病。这种变化的潜在解释可能包括西方国家人口老龄化、预期寿命的延长以及对 PAH 的认识不断提高和潜在有效治疗方法的出现。在老年人中进行严重肺动脉高压（PH）的诊断性检查时，应采用以下方法将衰老、肺血管疾病和其他常见继发性 PH 的原因（左心衰竭或肺部疾病）的预期后果区分开来。必须通过右心导管检查进行仔细的探索，但应特别注意该年龄段该程序的几个特定陷阱。这是一个值得关注的问题，因为旨在研究新的肺动脉高压特异性药物治疗的临床试验可能因纳入误诊患者而存在偏倚。本文的目的是强调在老年人中诊断 PAH 的主要困难，并提出一种实用方法，将 PAH 与该人群中其他常见 PH 的原因区分开来。
