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

¹ Dept of Pulmonology, and ² Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.

CORRESPONDENCE: H. Olschewski, Dept of Pulmonology, Medical University Graz, Auenbruggerplatz 20, 8036 Graz, Austria. E-mail: horst.olschewski{at}meduni-graz.at

Keywords: Exercise, pulmonary artery pressure, pulmonary hypertension, reference values, review, right heart catheterisation

Received: September 24, 2008
Accepted March 6, 2009

According to current guidelines, pulmonary arterial hypertension (PAH) is diagnosed when mean pulmonary arterial pressure (_pa) exceeds 25 mmHg at rest or 30 mmHg during exercise. Issues that remain unclear are the classification of _pa values <25mmHg and whether _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 _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.

_pa at rest was 14.0±3.3 mmHg and this value was independent of sex and ethnicity. Resting _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). _pa during exercise was dependent on exercise level and age. During mild exercise, _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 _pa at rest is virtually independent of age and rarely exceeds 20 mmHg, exercise _pa is age-related and frequently exceeds 30 mmHg, especially in elderly individuals, which makes it difficult to define normal _pa values during exercise.

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