One of the hottest areas in cardiovascular medicine is an old disease—pulmonary arterial hypertension—that has had a renaissance since 2000, with a huge expansion in the understanding of its pathophysiology and in the availability of new classes of drugs that can treat it. Thus, what was a devastating disease that appeared to be resistant to all the usual classes of cardiovascular drugs now has many new options for treatment—and better outcomes for patients.
This issue has two terrific articles. The first, by Ronald J. Oudiz, is a wonderful review of pulmonary arterial hypertension that provides new insights. He describes the history of initial investigation, and then notes major breakthroughs in understanding. Then he discusses the current endpoints in trials to help identify new treatments.
The second article, by Richa Agarwal and Mardi Gomberg-Maitland, provides a concise but in-depth review of treatment options and practical approaches to clinical management. They provide a helpful timeline that shows the ever-increasing progress of new therapies for pulmonary arterial hypertension, and then review the primary data supporting each therapy. They include a detailed diagram of the mechanisms of the various agents, demonstrating their complementary effects. They do conclude, though, that the story is not over—and that new therapies must be studied in this very hot area in cardiovascular disease.