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Sidney S. Braman, MD; Emmet Eby, MD; Charles Kuhn, MD; Sharon Rounds, MD

Arch Intern Med. 1991;151(12):2433-2438.

Abstract
Primary pulmonary hypertension is usually considered a disease of younger adults. We reviewed the natural course of primary pulmonary hypertension in patients aged 65 years or greater. During an 8-year period, 63 elderly patients were discharged from our hospital with a diagnosis of pulmonary hypertension. In eight instances, an elevated mean pulmonary arterial pressure (>25 mm Hg) could not be explained by secondary causes. These elderly patients with primary pulmonary hypertension had symptoms common to younger patients with this disease, including dyspnea (eight patients), chest pain (five), pedal edema (four), and fatigue (one). In all but one patient, the initial diagnosis was incorrect, and the patients were thought to have more common diseases of the elderly that cause similar symptoms. Coexisting medical problems were common and further obscured the correct diagnosis. Survival was significantly shorter in those patients with symptoms of less than 6 months' duration. Primary pulmonary hypertension should be considered in the differential diagnosis in elderly patients with unexplained dyspnea and chest pain.

(Arch Intern Med. 1991;151:2433-2438)

Author Affiliations
From the Department of Medicine, Rhode Island Hospital and Brown University, Providence, RI (Dr Braman); Department of Medicine, Toby Hospital, Wareham Mass (Dr Eby); Department of Pathology, Memorial Hospital of Rhode Island and Brown University (Dr Kuhn); and Department of Medicine, Providence Veterans Affairs Medical Center and Brown University (Dr Rounds). Presented in part at the Annual Meeting of the American Thoracic Society, Las Vegas, Nev, May 9, 1988.

Footnotes
Accepted for publication June 18, 1991.

Reprint requests to Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (Dr Eby).

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