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How is this different than regular hypertension? Won't the same medicines work?

As we have discussed previously, regular or systemic hypertension refers to elevated blood pressures in the arteries that carry blood from your heart (left ventricle) to the rest of the body. Pulmonary arterial hypertension is elevated pressures in the blood vessels (pulmonary arteries) that carry blood from the heart (right ventricle) to the lungs. Systemic blood pressures are higher than pulmonary arterial pressures, both in the normal state and in hypertension.

The mechanism by which hypertension is caused in these two circulations is also different. Hence, the medications used to treat them are also usually different. However, there is some overlap. For example, as mentioned earlier, one of the first line agents used to treat PAH are a class of medications called calcium channel blockers. When these are used to treat PAH, they may also reduce your systemic blood pressure. In fact, calcium channel blockers are very commonly used to treat regular hypertension, as well.

Most other medications normally used for systemic hypertension do not have a significant effect on the pulmonary pressures. The medications used for pulmonary hypertension are chosen because they are more "selective" for the pulmonary circulation (as opposed to the systemic circulation). That said, several of the medications used to treat PAH may have the side effect of reducing your systemic blood pressure because there may be some crossover effect. None of these medications is purely a selective pulmonary vasodilator.