The future of pulmonary hypertension

Rapidly evolving understanding of pulmonary vascular pathophysiology, pathways of vascular proliferation and remodeling, right ventricular adaptation and maladaptation, and right ventricular to pulmonary artery coupling have set the stage for an exciting future in the treatment of pulmonary arterial hypertension. Network biology, informatics, and the revolution in genomics, proteomics, and metabolomics promise even more advances in the years ahead. Combined with burgeoning availability of vasodilator therapy and ability to quantitate right ventricular function, this new understanding is poised to revolutionize therapeutic strategies. This chapter details the nature of these developments and provides perspective on the most promising approaches. The importance of proper clinical trial design, innovations in surrogate endpoints to guide phase II trial efficiency, and the need for collaboration across academia, clinical centers, the pharmaceutical industry and the private sector is emphasized.