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Pulmonary hypertension (PH) is often caused by left heart disease (LHD) such as heart failure (HF) or valvular heart disease. Historically, few randomized controlled trials have evaluated the off‐label use of medications for treating pulmonary arterial hypertension (PAH) in patients with PH‐LHD. However, multiple randomized controlled trials have been published over the last decade that investigated their use in patients with PH‐LHD. In addition, recent updates in the classification and definitions of PH have led to an improved recognition of PH‐LHD phenotypes, notably combined post‐capillary and pre‐capillary PH and isolated post‐capillary PH. In this systematic review, we show that PAH medications should not be recommended in two distinct HF populations: patients with HF without definitive PH diagnosis and patients with isolated post‐capillary PH due to HF. In addition, the use of bosentan or macitentan is …