Pulmonary hypertension (PH) is a serious, often misunderstood condition, characterised by abnormally high blood pressure in the arteries of the lung. Left untreated, it can lead to right heart failure and significantly reduce a person’s quality of life. Yet, despite its severity, PH can be difficult to detect and even harder to manage without adequate support.
At Wesley Research Institute, we’re working to change that. We’re investigating pulmonary hypertension to further understand this debilitating condition.
As the official research partner of UnitingCare and home to one of the country’s leading pulmonary hypertension research programs, we’re uniquely positioned to translate clinical research into better care and outcomes for people living with this condition.
From world-class clinical trials to developing patient-centred treatments, our team led by PH expert Dr John Feenstra is at the forefront of improving diagnosis, treatment, and long-term management for Australians affected by pulmonary hypertension.
Pulmonary Hypertension team at WRI, with patient Rosemary. Left to right: Dr John Feenstra, Rosemary, Bronwen Field, Marie-Louise Omega.
What is Pulmonary Hypertension?
Pulmonary hypertension (PH) is a complex and potentially life-threatening condition where the blood pressure in the arteries of the lungs becomes abnormally high. This increased pressure puts strain on the right side of the heart, making it work harder to pump blood into the lungs. Over time, this extra workload can lead to right heart enlargement and, eventually, heart failure.
It’s important to understand that PH is not the same as general high blood pressure (hypertension), which affects the systemic arteries. Pulmonary hypertension is specific to the pulmonary arteries the vessels that carry blood from the heart to the lungs.
What makes PH particularly challenging is that its symptoms are often subtle at first, such as shortness of breath or fatigue, and can be mistaken for other conditions like asthma or anxiety. As a result, many people go undiagnosed for years, by which time the disease may have already progressed.
Why Early Awareness Matters
Pulmonary hypertension is rare, but it is serious. Without treatment, the condition typically worsens over time. However, with early detection and proper management, people with PH can live longer and maintain a better quality of life.
At Wesley Research Institute, we focus not only on improving treatment options but also on supporting earlier, more accurate diagnosis. Our goal is to ensure more people receive the right care, sooner.
A Research-Led Definition
From a clinical research perspective, PH is diagnosed when mean pulmonary arterial pressure (mPAP) exceeds 20 mmHg at rest, as measured by a right heart catheter. However, this number tells only part of the story. PH comes in several forms, each with its own causes and implications. Understanding these is the first step toward effective treatment, which we’ll explore in the chapters ahead.
What Causes Pulmonary Hypertension?
Pulmonary hypertension doesn’t have a single cause; rather, it can arise from a wide range of underlying conditions. In some cases, the cause is clear. In others, it may develop without an identifiable reason. Understanding what leads to PH is crucial not only for diagnosis, but also for determining the most effective treatment path.
Common Causes of Pulmonary Hypertension
PH is broadly classified into five different groups, based on its underlying cause. These classifications help guide both diagnosis and treatment:
Group 1: Pulmonary Arterial Hypertension (PAH)
What it is:
A rare form of PH involving direct damage or dysfunction in the small arteries of the lungs. These vessels become narrow or blocked, raising the pressure in the pulmonary circuit.
Common causes include:
- Idiopathic PAH (no known cause)
- Heritable PAH (genetic mutations)
- PAH associated with connective tissue diseases, autoimmune conditions, HIV, liver disease, or congenital heart disease
- Drug-induced PAH (some weight-loss drugs, methamphetamines for example)
Treatment considerations:
Targeted therapies, such as endothelin receptor antagonists, PDE-5 inhibitors and prostacyclin analogues, are commonly used to manage this group. Wesley Research Institute is involved in ongoing research into newer, more effective PAH treatments.
Group 2: PH Due to Left Heart Disease
What it is:
The most common type of PH, caused by conditions that impair the function of the left side of the heart. When the heart can’t pump efficiently, blood backs up into the lungs.
Often seen in patients with:
- Heart failure with preserved or reduced ejection fraction
- Valvular heart disease (such as mitral or aortic valve disease)
Treatment considerations:
Managing the underlying heart condition is key. PAH-specific therapies are generally not effective in this group and may be harmful if misused. Clinical trials are being conducted at WRI for this group of patients.
Group 3: PH Due to Lung Diseases and/or Low Oxygen
What it is:
This type is triggered by chronic lung conditions or long-term low oxygen levels. Damage to the lungs increases resistance in the pulmonary arteries.
Linked to:
- COPD (chronic obstructive pulmonary disease)
- Pulmonary fibrosis
- Long-term exposure to high altitude
Treatment considerations:
Focus is on improving oxygenation and treating the underlying lung disease. Clinical trials are ongoing — including at Wesley Research — to evaluate whether new targeted PH medications may have a role in some patients.
Group 4: Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
What it is:
Caused by unresolved blood clots in the lungs that lead to chronic blockages in the pulmonary arteries. Unlike other types of PH, this one can often be treated with surgery, balloon pulmonary angioplasty or medical therapy.
Key facts:
- May develop after a pulmonary embolism
- Often underdiagnosed
- Requires specialised imaging (such as V/Q scan or pulmonary angiogram) for detection
- A team of medical professionals review each individual CTEPH case
Treatment considerations:
Pulmonary endarterectomy surgery is the gold standard. For inoperable cases, balloon pulmonary angioplasty or medical therapy may be offered.
Group 5: PH with Unclear or Multifactorial Causes
What it is:
A catch-all group for cases where PH arises from multiple factors or doesn’t fit neatly into other categories. Often involves rare conditions such as:
- Sarcoidosis
- Chronic kidney disease
- Certain blood or metabolic disorders
Treatment considerations:
These cases are often complex and require highly personalised care, guided by a multidisciplinary team. Research is ongoing to better define and treat this group.
Why Accurate Classification Matters
We see firsthand how proper classification can dramatically improve patient outcomes. Each PH type has a different mechanism and different treatment implications. That’s why early referral to a specialist PH centre and access to advanced testing is so important.
How Wesley Research Is Helping Uncover the “Why”
Wesley Research Institute is not only helping to classify pulmonary hypertension more accurately — we’re actively investigating new and emerging causes of the condition through advanced diagnostics and clinical trials.
By understanding what causes PH in different groups of people, our researchers and clinicians are working to develop personalised treatments that improve outcomes, especially in patients who don’t respond well to standard therapies.
The Future of Pulmonary Hypertension Research
Over the past two decades, pulmonary hypertension (PH) has shifted from being a little-understood, frequently fatal condition to one that is increasingly manageable — and in some cases, treatable — thanks to research-led innovation.
But there’s still work to do.
At Wesley Research Institute, we believe that the future of PH care lies in precision and personalised medicine, earlier diagnosis, and treatments that are not only more effective but also better tailored to each individual. Our research team is leading efforts in these areas and working to bring real, measurable change to people living with PH.
Led by respected PH clinician and researcher Dr John Feenstra, our Pulmonary Hypertension Research Program is one of Australia’s leading efforts dedicated to:
- Investigating therapies for all four major PH groups
- Reducing the time to diagnosis through advanced screening
- Improving access to clinical trials across Queensland
- Contributing to international research collaborations
The Role of Clinical Trials in Shaping the Future
Clinical trials are a cornerstone of PH innovation. Participating in a trial can offer access to cutting-edge therapies before they are publicly available and help future patients benefit from what we learn today.
If you or someone you know is living with PH, speak to your specialist about whether a clinical trial might be right for you.
A Message of Hope
The future of pulmonary hypertension is brighter than it’s ever been — because of people like you. Patients who ask questions. Families who advocate. Clinicians who push for answers. And researchers who refuse to stop until better solutions are found.
Wesley Research Institute is proud to be part of that journey. Together, we’re not only extending lives, we’re working to improve the way those lives are lived.
If you’re living with pulmonary hypertension or caring for someone who is, we encourage you to:
- Speak to a specialist about your options and referral to a PH centre
- Explore clinical trials available through Wesley Research Institute
- Reach out for support — from your care team, your community, or organisations like PHA Australia
- Stay informed by following our latest research and patient resources
Together, we can continue building a future where pulmonary hypertension is not only treatable but manageable, with dignity and quality of life.