Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review

According to current guidelines, pulmonary arterial hypertension (PAH) is diagnosed when mean pulmonary arterial pressure ((P) over bar (pa)) exceeds 25 mmHg at rest or 30 mmHg during exercise. Issues that remain unclear are the classification of (P) over bar (pa) values < 25mmHg and whether (P) over bar (pa) > 30 mmHg during exercise is always pathological. We performed a comprehensive literature review and analysed all accessible data obtained by right heart catheter studies from healthy individuals to determine normal (P) over bar (pa) at rest and during exercise. Data on 1,187 individuals from 47 studies in 13 countries were included. Data were. stratified for sex, age, geographical origin, body position and exercise level. (P) over tilde (pa) at rest was 14.0 +/- 3.3 mmHg and this value was independent of sex and ethnicity. Resting (P) over bar (pa) was slightly influenced by posture (supine 14.0 +/- 3.3 mmHg, upright 13.6 +/- 3.1 mmHg) and age (< 30 yrs: 12.8 +/- 3.1mmHg; 30-50 yrs: 12.9 +/- 3.0 mmHg; >= 50 yrs: 14.7 +/- 4.0 mmHg). (P) over bar (pa) during exercise was dependent on exercise level and age. During mild exercise, (P) over bar (pa) was 19.4 +/- 4.8 mmHg in subjects aged < 50 yrs compared with 29.4 +/- 8.4 mmHg in subjects >= 50 yrs (p < 0.001). In conclusion, while (P) over bar (pa) at rest is virtually independent of age and rarely exceeds 20 mmHg, exercise (P) over bar (pa) is age-related and frequently exceeds 30 mmHg, especially in elderly individuals, which makes it difficult to define normal (P) over bar (pa) values during exercise.