Pulmonary hypertension

Signs and Symptoms

The most common symptom of pulmonary hypertension is shortness of breath, first when you exercise and later while at rest. Other symptoms include:

• Getting tired easily
• Fainting or dizziness
• Cough
• Chest pain
• Swelling in your legs
• Blue lips or skin

What Causes It?

Sometimes there is no known cause. In that case, the condition is called idiopathic pulmonary hypertension. If another medical condition is causing the problem, it is called secondary pulmonary hypertension. Conditions that can lead to pulmonary hypertension include:

• Heart disease
• Mitral stenosis or regurgitation
• Certain kinds of lung disease
• Obesity, especially with sleep apnea
• Chronic obstructive pulmonary disease (COPD)
• High altitude
• Left side heart failure
• Sickle cell anemia
• Among infants, low birth weight

What to Expect at Your Doctor's Office

Your doctor will give you a thorough examination and order laboratory tests to diagnose your condition. You may have an x-ray or electrocardiogram (ECG). Other tests may include an echocardiogram, heart catheterization, lung scan, computerized tomography (CT) scan, or magnetic resonance imaging (MRI).

Treatment Options

If you have pulmonary hypertension because of another condition, that condition must be treated. You should avoid too much physical stress or exercise, although mild, regular exercise may help reduce symptoms like shortness of breath. Ask your doctor to create an exercise plan for you. If your disease has progressed, your doctor may recommend you have a lung or heart transplant.

Drug Therapies

Some treatments your doctor may use include:

• Supplemental oxygen
• Vasodilators. Open narrowed arteries. Epoprostenol (Flolan) is given intravenously (IV) through a small catheter attached to a portable pump. Iloprost (Ventavis) is a version of the same drug that you inhale.
• Endothelin receptor antagonists. Helps open blood vessels by blocking endothelin, a substance that causes blood vessels to constrict. These drugs include bosentan (Tracleer) and ambrisentan (Letairis).
• Anticoagulants, such as warfarin (Coumadin) to keep blood clots from forming.
• Diuretics (water pills). To get rid of excess fluid in your body that can build up in your lungs and make your heart work harder.
• Antioxidants. To regulate pulmonary vascular tone and thicken smooth muscle.

Complementary and Alternative Therapies

If you have pulmonary hypertension, you should be under a conventional medical doctor's care. Make sure your doctor knows about any herbs or supplements you may be thinking about using. DO NOT use complementary and alternative therapies (CAM) by themselves to treat pulmonary hypertension, unless directed to do so by your doctor.

While none of these supplements specifically treats pulmonary hypertension, they may help heart health and function.

• Coenzyme Q10 (CoQ10). Good for heart health, and may help lower blood pressure. DO NOT take CoQ10 if you take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix). CoQ10 may increase clotting and make these medications less effective.
• L-carnitine. Improves endurance and is good for heart health. DO NOT take L-carnitine if you take blood thinners or thyroid hormone.
• Magnesium. Helps your heart work better and may help lower blood pressure. Magnesium interacts with many medications, as well as other herbs and supplements. So talk to your doctor before taking magnesium.
• Potassium. Helps heart muscle contract. If you take a certain kind of diuretic, your doctor may tell you to take a potassium supplement. Your doctor will tell you how much to take. DO NOT take potassium on your own, however. If you take another kind of diuretic, taking a potassium supplement could be dangerous. Ask your doctor before taking extra potassium.
• Vitamin E and vitamin C. Antioxidants that protect the heart and strengthen the immune system. DO NOT take vitamin E if you take blood thinners. Vitamin E can interact with a number of medications. So ask your doctor before taking it.
• Taurine. Good for heart health and may help lower blood pressure. Taurine may act like a diuretic, so DO NOT take it if you already take a diuretic (water pill), or if you take lithium.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

DO NOT take these herbs without your doctor's supervision. Many interact with each other and with other prescription medications. And they can cause unwanted side effects. These herbs have not been studied specifically for pulmonary hypertension.

• Hawthorn (Crataegus monogyna). Hawthorn has been shown to help reduce symptoms of heart failure. Some people think it may help lower blood pressure, although so far studies are lacking. Hawthorn interacts with many drugs taken to treat heart disease, high blood pressure, and heart failure.
• Linden (Tilia cordata). May help the body get rid of excess fluid. Strain and cool. DO NOT take linden if you take diuretics (water pills) or lithium.
• Garlic (Allium sativum). May help lower blood pressure. Garlic may increase the risk of bleeding, especially if you take blood thinners, such as warfarin (Coumadin). Garlic may also interact with other medications. Ask your doctor before taking garlic.
• Rosemary (Rosmarinus officinalis). May help the body get rid of excess fluid. DO NOT take rosemary if you take diuretics (water pills). Speak to your doctor if you are taking blood-thinning medications, such as warfarin (Coumadin) or aspirin, among others.
• Danshen (Salvia miltiorrhiza). Dilates blood vessels. DO NOT take danshen if you take blood thinners (anticoagulants). Danshen may also interact with other drugs, including clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin), diltiazem (Cardizem), lovastatin (Mevacor), birth control pills, and many others.

Homeopathy may be helpful when used along with conventional medical treatment.

Castor oil pack. Apply oil to a clean, soft cloth, place on chest and cover with plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes. Use for 3 consecutive days, take 1 to 2 days off, and then repeat 3-day cycle.

Contrast hydrotherapy. Alternate hot and cold applications to the chest. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times to complete 1 set. Do 2 to 3 sets per day.

Steams. Using 3 to 6 drops of essential oils in a humidifier, vaporizer, atomizer, or warm bath may help reduce shortness of breath and improve circulation. Consider eucalyptus, rosemary, thyme, or lavender.

Acupuncture may help improve circulation.

Following Up

Pulmonary hypertension gets worse over time, and it may lead to heart failure of other heart complications. It is important to work closely with your doctor to treat your symptoms and adjust your medication as needed.

Special Considerations

For the most part, women who have primary pulmonary hypertension should not get pregnant because the condition is dangerous for both mother and baby.

Supporting Research

Batyraliev LI, Makhmutkhodzhaev SA, Ecinci E, et al. Pulmonary hypertension and right ventricular failure. Part VI. Classification and pathomorphology of primary pulmonary arterial hypertension. Kardiologiia. 2007;47(1):75-81.

Bech-Hanssen O, Karason K, Rundqvist B, Bollano E, Lindgren F, Selimovic N. Can pulmonary hypertension and increased pulmonary vascular resistance be ruled in and ruled out by echocardiography? J Am Soc Echocardiogr. 2013;26(5):469-78.

Bhat R, Salas AA, Foster C, Carlo WA, Ambalavannan N. Prospective analysis of pulmonary hypertension in extremely low birth weight infants. Pediatrics. 2012;129(3):e682-9.

Chen ZY, Peng C, Jiao R, Wong YM, Yang N, Huang Y. Anti-hypertensive nutraceuticals and functional foods. J Agric Food Chem. 2009 Jun 10;57(11):4485-99. Review.

Coulden R. State-of-the-art imaging techniques in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3(7):577-83.

El Bardai S, Morel N, Wibo M, et al. The vasorelaxant activity of marrubenol and marrubiin from Marrubium vulgare. Planta Med. 2003;69(1):75-77.

Gaine SP, Orens JB. Lung transplantation for pulmonary hypertension. Semin Respir Crit Care Med. 2001;22(5):533-40.

Gerges M, Gerges C, Pistritto AM, et al. Pulmonary hypertension in heart failure. Epidemiology, right ventricular function, and survival. Am J Respir Crit Care Med. 2015;192(10):1234-46.

Houston MC. Treatment of hypertension with nutraceuticals, vitamins, antioxidants and minerals. Expert Rev Cardiovasc Ther. 2007 Jul;5(4):681-91.

Kassab R, Hamdan R, El AB, Azar R, Salame E. Beneficial effect of sildenafil following surgery for mitral stenosis complicated by pre-capillary pulmonary hypertension: report of two cases. Ann Cardiol Angeiol. 2006;55(5):286-90.

Kreitner KF. Noninvasive imaging of pulmonary hypertension. Semin respir Crit Care Med. 2014;35(1):99-111.

Mair KM, Wright AF, Duggan N, et al. Sex-dependent influence of endogenous estrogen in pulmonary hypertension. Am J Respir Crit Care Med. 2014;190(4):456-67.

Orr R, Smith LJ, Cuttica MJ. Pulmonary hypertension in advanced chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2012;18(2):138-43.

Porta N, Steinhorn R. Pulmonary vasodilator therapy in the NICU: Inhaled nitric oxide, sildenafil, and other pulmonary vasodilating agents. Clinics in Perinatology. 2012;39(1).

Ried K, Frank OR, Stocks NP, Fakler P, Sullivan T. Effect of garlic on blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2008 Jun 16;8:13. Review.

Said SI. Mediators and modulators of pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol. 2006;291(4):L547-58.

Smith HA, Canter JA, Christian KG, et al. Nitric oxide precursors and congenital heart surgery: a randomized controlled trial of oral citrulline. J Thorac Cardiovasc Surg. 2006;132:58-65.

Suzuki YJ, Steinhorn RH, Gladwin MT. Antioxidant therapy for the treatment of pulmonary hypertension. Antioxid Redox Signal. 2013;18(14):1723-6.

Voelkel NF, Bogaard HJ, Husseini Al, Farkas L, Gomez-Arroyo J, Natarajan R. Antioxidants for the treatment of patients with severe angioproliferative pulmonary hypertension. Antioxid Redox Signal. 2013;18(14):1810-7.

Wirth G, Bruggermann K, Bostel T, Mayer E, Duber C, Kreitner KF. Chronic thromboembolic pulmonary hypertension (CTEPH) - potential role of multidetector-row CT (MD-CT) and MR imagining in the diagnosis and differential diagnosis of the disease. Rofo. 2014;186(8):751-61.

Zagolin BM, Wainstein GE, Uriarte GP. Update in the diagnosis and therapy for pulmonary arterial hypertension. Rev Med Chil. 2006;134(7):902-9.

Zapfe jun G. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine. 2001;8:262-6.

Zick SM, Vautaw BM, Gillespie B, Aaronson KD. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail. 2009 Oct;11(10):990-9.