Therapy for Pulmonary Arterial Hypertension in Adults James R. Klinger, MD, FCCP, C. Gregory Elliott, MD, FCCP, Deborah J. Levine, MD, FCCP, Eduardo Bossone, MD, PhD, FCCP, Laura Duvall, PharmD, BCPS, Karen Fagan, MD, Julie Frantsve-Hawley, PhD, Steven M. Kawut, MD, John J. Ryan, MD, Erika B. Rosenzweig, MD, Nneka Sederstrom, PhD, FCCP, Virginia D. Steen, MD, David B. Badesch, MD, FCCP  CHEST  Volume 155, Issue 3, Pages 565-586 (March 2019) DOI: 10.1016/j.chest.2018.11.030 Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 1 Guideline algorithm for pharmacologic therapy for PAH in adults. Where multiple drug options are provided, there is no comparative effectiveness data to suggest greater benefit of one therapy over the other. In these situations, other factors, such as patient preferences & values, cost, and insurance coverage, may guide decision-making. CCB = calcium channel blocker; 6MWD = 6-min walk distance; FC = functional class; PAH = pulmonary arterial hypertension; PH = pulmonary hypertension; RV = right ventricular; WHO = World Health Organization. CHEST 2019 155, 565-586DOI: (10.1016/j.chest.2018.11.030) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 1 Guideline algorithm for pharmacologic therapy for PAH in adults. Where multiple drug options are provided, there is no comparative effectiveness data to suggest greater benefit of one therapy over the other. In these situations, other factors, such as patient preferences & values, cost, and insurance coverage, may guide decision-making. CCB = calcium channel blocker; 6MWD = 6-min walk distance; FC = functional class; PAH = pulmonary arterial hypertension; PH = pulmonary hypertension; RV = right ventricular; WHO = World Health Organization. CHEST 2019 155, 565-586DOI: (10.1016/j.chest.2018.11.030) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 1 Guideline algorithm for pharmacologic therapy for PAH in adults. Where multiple drug options are provided, there is no comparative effectiveness data to suggest greater benefit of one therapy over the other. In these situations, other factors, such as patient preferences & values, cost, and insurance coverage, may guide decision-making. CCB = calcium channel blocker; 6MWD = 6-min walk distance; FC = functional class; PAH = pulmonary arterial hypertension; PH = pulmonary hypertension; RV = right ventricular; WHO = World Health Organization. CHEST 2019 155, 565-586DOI: (10.1016/j.chest.2018.11.030) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 2 Combination therapy algorithm. Where multiple drug options are provided, there is no comparative effectiveness data to suggest greater benefit of one therapy over the other. In these situations, other factors, such as patient preferences & values, cost, and insurance coverage, may guide decision-making. See Figure 1 for Boxes 1 and 2. See Figure 1 legend for expansion of abbreviations. CHEST 2019 155, 565-586DOI: (10.1016/j.chest.2018.11.030) Copyright © 2019 American College of Chest Physicians Terms and Conditions

Figure 3 General measures algorithm. CHEST 2019 155, 565-586DOI: (10.1016/j.chest.2018.11.030) Copyright © 2019 American College of Chest Physicians Terms and Conditions