Pre-capillary pulmonary hypertension in elderly patients: a descriptive study

Pulmonary hypertension (PH) is a serious medical condition subsequently complicating many other common diseases. PH seems to be increasing in the elderly; however, it has been poorly studied in this group. The aim of this study was to determine the diagnostic and prognosis features as well as management of pre-capillary PH in the elderly compared to young subjects. We performed a single center retrospective study in the Regional Hospital of Reims, France. Patients with precapillary PH diagnosed by right cardiac catheterization between January 2008 and December 2016 were included. Elderly patients (aged ≥65 years at diagnosis) were compared to younger patients (18-64 years). Patients with post-capillary PH were excluded. A total of 146 patients were included, 82 patients were aged 65 years or more (median age 74 years (68-78), 56% women) and 64 non-elderly (median age 54 years (48-61, 5), 52% women). In the elderly group, 31.7% had pulmonary arterial hypertension (PAH): 15% idiopathic PAH, 36.6% WHO group 3 PH and 28% WHO group 4 PH, with no significant differences with younger patients. In the group of 56 patients with PAH, 26 were elderly (46%). Frequency of comorbidities was similar in both groups, except for arterial hypertension more prevalent in the elderly (52% vs. 34%, p = 0.029). Older patients often had lower extremities oedema (53.3% vs 36.2%, p = 0.045) and reduced 6-minutes walking distance (189 m vs 289, p = 0.004). Younger patients had lower FEV1 (58% vs 75%, p = 0.003) and higher right atrial pressure (12 vs 9, p = 0.023). Oxygenotherapy and diurectis were more often used in elderly subjects (58.5% vs. 34.4%, p = 0.004) and (82.9% vs. 67.2%, p = 0.027) respectively. Three-year and five-year survival were lower in elderly patients (53% and 24%, vs 86% and 63%, p = 0.003 and p=0.004 respectively). PH mainly affects individuals aged 65 years and more. Post-capillary PH is more prevalent but precapillary PH could be encountered. Clinical and paraclinical features seem to be similar in both groups. This entity has a worse impact on general health in elderly patient and the prognosis is poor.