Lung Consolidation: What It Feels Like and How To Treat It
Poor Nutritional Index Scoring Predicts Worse Outcomes For PAH, Study Finds
This retrospective study found associations between inferior nutritional index scores, malnutrition, and prognoses in patients with pulmonary arterial hypertension (PAH).
Malnutrition is linked to worse outcomes for patients with pulmonary arterial hypertension (PAH), according to a study published in Pulmonary Circulation.
PAH often causes right-heart failure. Outside of PAH, heart failure is known to affect one's appetite, nutritional absorption, and lead to malnutrition. For this reason, nutritional assessments are routinely recommended for patients who experience heart failure; however, despite PAH's association with heart failure, there is a gap in knowledge regarding the influence of malnutrition on PAH outcomes.
The referenced nutritional assessments mainly analyze scores from the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT). GNRI is calculated by serum albumin levels and lower scores here indicate worse outcomes. PNI is a tool for measuring lymphocytes and worse outcomes are also indicated by lower scoring. CONUT assessments also total lymphocytes while additionally including cholesterol and factors in lipid metabolism; however, higher CONUT scores are associated with worse outcomes.
Although these assessments have confirmed the connection between heart failure outcomes and worse scores, they have not produced conclusive evidence that makes direct associations between poor scoring and PAH prognosis. Taking this into account, researchers set out to evaluate correlations between nutritional status and all-cause death or pulmonary transplants occurring in patients after a PAH diagnosis.
Data were gathered from patients cared for at Okayama University Hospital in Japan between January 1997 and October 2018. In total, 80 with PAH were eligible for analysis. Researchers evaluated their blood results and physical examinations (which included measuring a 6-minute walking distance exercise) to generate GNRI, PNI, and CONUT scores. Patients were divided into 2 prognostic groups: survivors and nonsurvivors.
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Patients had a mean age of 59 years and were followed up with for an average of 5.5 years. Twenty-three of the patients were men, and 57 were women. Of the 80 patients included, 24 died over the course of this study and 3 required lung transplantations.
The authors found significantly different prognostic outcomes related to the sex of nonsurvivors and survivors (44.4% women vs 20.8% men; P = .002), as well as right arterial pressure (7.8 mm Hg vs 5.5 mm Hg; P = .02) and 6-minute walking distance (272 m vs 386 m; P = .002).
Nonsurvivors and survivors also exhibited significant differences in serum albumin (3.5 g/dL vs 4.0 g/dL; P = .002), brain natriuretic peptides (257.3 pg/mL vs 78.6 pg/mL; P = .008), serum creatinine (0.8 mg/dL vs 0.7 mg/dL; P = .044), and total cholesterol (154.3 mg/dL vs 174.9 mg/dL; P = .041).
Worse prognoses were apparent for patients who scored worse in the GNRI, PNI, and CONUT. These results show a significant association between nutritional status, malnutrition, and prognosis for patients with PAH. As such, the authors believe these assessments should be regarded as useful tools for predicting and evaluating patients' risk in the future.
In their closing remarks, the authors took time to note the remaining complexities of studies concerning PAH and nutrition. Of those intricacies, some of particular interest include the causal link between PAH-targeting medication and nutritional status. In a myriad of ways, many of these medications contribute to poorer nutritional standing in patients with PAH. In the same breath, the researchers reiterate PAH's influence on the heart and malnourishment. Their conclusion touches on 2 very important concerns that impact outcomes for patients with PAH. Because of this, they encourage further studies to continue exploring the associations between nutritional factors and PAH.
Reference
Nakashima M, Akagi S, Ejiri K, Nakamura K, Ito H. Impact of malnutrition on prognosis in patients with pulmonary arterial hypertension. Pulm Circ. 2023;13(3):e12286. Doi:10.1002/pul2.12286
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Can High Blood Pressure Cause Shortness Of Breath?
Not being able to catch your breath is scary, but shortness of breath can occur in a wide range of medical conditions, including high blood pressure and pulmonary hypertension.
Traditional hypertension (high blood pressure) is diagnosed when your heart has to beat harder and with more force to overcome narrow or blocked blood vessels in your body. This problem can be the result of things like high cholesterol and hardening of the arteries.
Pulmonary hypertension — high blood pressure affecting the heart and lungs — sounds similar, but in this case, the increased pressure in the blood vessels of the lungs may not be widespread. Instead, the real problem is with the pressure in the arteries that move blood between your heart and lungs.
Read on for more about how high blood pressure can affect your breathing and other ways your blood pressure might be linked to shortness of breath.
Learn more about shortness of breath (dyspnea).
High blood pressure may not cause noticeable symptoms, which is why it's called "the silent killer."
When you have high blood pressure, your heart has to work much harder to pump blood to your entire body. Overworking your heart can, over time, lead to a number of other health problems like cardiovascular disease, which can cause shortness of breath as a symptom.
Some people with hypertension may experience a hypertensive emergency or crisis during which their blood pressure becomes extremely elevated. This medical emergency can cause shortness of breath because of the associated edema or swelling. A hypertensive crisis is a medical emergency and requires immediate medical care.
Pulmonary hypertension is a type of high blood pressure affecting the heart and lungs. It develops when the pressure inside the vessels that move blood between your heart and lungs is high.
Blood that has returned from circulation in your body and has been depleted of oxygen cycles through the heart and then onto the lungs, where it's enriched with fresh oxygen before returning to the heart for system-wide circulation.
Shortness of breath or labored breathing can lead to all kinds of complications, whether the cause is hypertension or something else.
Untreated shortness of breath can cause hypoxia, which is low levels of oxygen in your blood and tissues. When this happens, certain tissues — especially critical organs like the brain and heart — become permanently injured or destroyed.
Additionally, untreated high blood pressure can increase your risk of developing a wide range of cardiovascular problems, including heart disease and even stroke or heart attack.
For pulmonary hypertension, in particular, the main complication to watch for is heart failure. Long-term overworking of the heart actually enlarges and weakens cardiac muscles, and your heart pumps less effectively. When this happens, oxygenated blood can't get to where it needs to go, resulting in tissue damage and other serious problems.
General hypertension can be treated with a combination of diet and lifestyle changes and medications. If you have pulmonary hypertension specifically, you may be prescribed various inhaled, oral, or intravenous medications or even oxygen therapy.
Like with general hypertension, you should also consider making the following changes, if applicable:
There are five main types of pulmonary hypertension, and your treatment will depend on which group yours falls into. The different types of pulmonary hypertension are grouped by the cause, underlying conditions, and symptoms you experience.
While a specific diagnosis may make treatment options seem promising, there's really no cure for pulmonary hypertension. Instead, your healthcare professional will work with you to manage your symptoms and prevent additional complications.
There's no singular cure for pulmonary hypertension, and even symptom management and ongoing treatments can be complicated by the management of other health problems you may have.
Managing conditions like heart failure and other cardiovascular diseases can help you keep pulmonary hypertension from leading to potentially life threatening complications.
However, with the right lifestyle changes and medications, you and your healthcare professional can develop a treatment strategy that can help you maintain and stay active.
Not all cases of general high blood pressure or pulmonary hypertension are preventable, but there are several things you can do to reduce your chances of these conditions and other cardiovascular diseases.
Quitting smoking, eating a nutritious diet, and getting regular exercise are all helpful, but it's also important to take any medications your healthcare professional prescribes you.
Failure to take medications that are meant to control things like your cholesterol and blood pressure could lead to many other health issues, complications, and symptoms like shortness of breath.
Is pulmonary hypertension curable?Pulmonary hypertension isn't really curable, but it's treatable. Your doctor will prescribe things like medications and things like oxygen therapy to help you manage your symptoms.
Does pulmonary hypertension run in families?Not all pulmonary hypertension is inherited, but the condition does run in some families. Tell your doctor if you know of a close blood relative with pulmonary hypertension.
Is shortness of breath from pulmonary hypertension fatal?Shortness of breath for any reason can be life threatening if it becomes severe enough. If you experience shortness of breath that causes symptoms like fainting, lightheadedness, confusion, or loss of consciousness, seek immediate medical attention.
Hypertension, heart failure, and other cardiovascular diseases can all develop into serious medical issues that may appear with shortness of breath.
Pulmonary hypertension, a type of high blood pressure that develops in the blood vessels between your heart and lungs, is the main kind of hypertension that results in shortness of breath.
If you have frequent or severe shortness of breath, discuss your symptoms with your healthcare professional as soon as possible to avoid potentially dangerous complications.
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