{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:11:36Z","timestamp":1790629896402,"version":"4.1.0"},"reference-count":48,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T00:00:00Z","timestamp":1702684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Chronic obstructive pulmonary disease-associated pulmonary hypertension (PH-COPD) results in a significant impact on symptoms, quality of life, and survival. There is scant and conflicting evidence about the use of pulmonary hypertension (PH) specific therapy in patients with PH-COPD. Study Design and Methods: PubMed, OVID, CINAHL, Cochrane, Embase, and Web of Science were searched using various MESH terms to identify randomized controlled trials (RCTs) or observational studies investigating PH-specific therapies in patients with severe PH-COPD, defined by mean pulmonary artery pressure (mPAP) of more than 35 mm Hg or pulmonary vascular resistance (PVR) of more than 5 woods units on right heart catheterization. The primary outcome was a change in mPAP and PVR. Secondary outcomes were changes in six-minute walk distance (6MWD), changes in the brain-natriuretic peptide (BNP), New York Heart Association (NYHA) functional class, oxygenation, and survival. Results: Thirteen studies satisfied the inclusion criteria, including a total of 328 patients with severe PH-COPD. Out of these, 308 patients received some type of specific therapy for PH. There was a significant reduction in mPAP (mean difference (MD) \u22123.68, 95% CI [\u22122.03, \u22125.32], p &lt; 0.0001) and PVR (MD \u22121.40 Wood units, 95% CI [\u22121.97, \u22120.82], p &lt; 0.00001). There was a significant increase in the cardiac index as well (MD 0.26 L\/min\/m2, 95% CI [0.14, 0.39], p &lt; 0.0001). There were fewer patients who had NYHA class III\/lV symptoms, with an odds ratio of 0.55 (95% CI [0.30, 1.01], p = 0.05). There was no significant difference in the 6MWD (12.62 m, 95% CI [\u22128.55, 33.79], p = 0.24), PaO2 (MD \u22122.20 mm Hg, 95% CI [\u22124.62, 0.22], p = 0.08), or BNP or NT-proBNP therapy (MD \u22120.15, 95% CI [\u22120.46, 0.17], p = 0.36). Conclusion: The use of PH-specific therapies in severe PH-COPD resulted in a significant reduction in mPAP and PVR and increased CI, with fewer patients remaining in NYHA functional class III\/IV. However, no significant difference in the 6MWD, biomarkers of right ventricular dysfunction, or oxygenation was identified, demonstrating a lack of hypoxemia worsening with treatment. Further studies are needed to investigate the use of PH medications in patients with severe PH-COPD.<\/jats:p>","DOI":"10.3390\/jcdd10120498","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T08:55:29Z","timestamp":1702889729000},"page":"498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pulmonary Vasodilator Therapy in Severe Pulmonary Hypertension Due to Chronic Obstructive Pulmonary Disease (Severe PH-COPD): A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0705-1137","authenticated-orcid":false,"given":"Ahmed","family":"Elkhapery","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3422-5163","authenticated-orcid":false,"given":"M. Bakri","family":"Hammami","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Sulica","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, New York University Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemanth","family":"Boppana","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Abdalla","sequence":"additional","affiliation":[{"name":"Rochester General Hospital Research Institute, Rochester, NY 14621, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charoo","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazem","family":"Taifour","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Unity Hospital, Rochester, NY 14626, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengu","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2086-1281","authenticated-orcid":false,"given":"Himanshu","family":"Deshwal","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur. 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