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The Fifth World Symposium on Pulmonary Hypertension, 2013, established a new classification of pulmonary hypertension (PH), and a new definition was released in 2015, which impacted the case identification parameters for Pulmonary hypertension (SMQ). A decision was therefore made to revise Pulmonary hypertension (SMQ). A new definition and new inclusion/exclusion criteria were established, based upon the conclusions of the Fifth World Symposium on Pulmonary Hypertension, and of The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). The updated term list was subjected to testing. PH has previously been defined as a resting mean pulmonary arterial pressure (mPAP) > 25 mm Hg, or an mPAP with exercise > 30 mm Hg. The subgroup of PH known as pulmonary arterial hypertension (PAH) adds the criterion that the pulmonary arterial wedge pressure must be <= 15 mm Hg. Some definitions have also included pulmonary vascular resistance (PVR), requiring that it be >= 2 or 3 Wood units. Potential weaknesses of the previous definition are that the level, type, and posture of exercise had not been specified. Furthermore, the normal exercise pulmonary arterial pressure (PAP) varies with age. Clarification of the definition based on available evidence was an important objective of the 2015 ESC/ERS guideline. The new definition of PH is a resting mPAP >= 25 mm Hg. Further studies are needed to better determine the natural history of patients with mPAP 21 to 24 mm Hg. The exercise and PVR criteria should be eliminated. A resting mPAP of 8 to 20 mm Hg should be considered normal, based on available evidence.
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