Riociguat for Pulmonary Hypertension

To the Editor: With regard to the articles on the Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase–Stimulator Trial 1 (CHEST-1) and the Pulmonary Arterial Hypertension Soluble Guanylate Cyclase–Stimulator Trial 1 (PATENT-1) by Ghofrani et al. (July 25 issue) 1 , 2 and the corresponding editorial by Archer, 3 we agree that pharmacotherapy should be available to patients with inoperable disease. However, the observed improvements in exercise capacity with riociguat for chronic thromboembolic pulmonary hypertension are inferior in magnitude, and their durability is unknown, as compared with reported outcomes after surgery, which is associated with an approximate 2% mortality and is curative in many . . .