title: Pharmacologic therapy for pulmonary arterial hypertension in adults: CHEST guideline and expert panel report.
abstract: OBJECTIVE
  Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. The objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence.
  
  
  METHODS
  This guideline was based on systematic reviews of English language evidence published between 1990 and November 2013, identified using the MEDLINE and Cochrane Library databases. The strength of available evidence was graded using the Grades of Recommendations, Assessment, Development, and Evaluation methodology. Guideline recommendations, or consensus statements when available evidence was insufficient to support recommendations, were developed using a modified Delphi technique to achieve consensus.
  
  
  RESULTS
  Available evidence is limited in its ability to support high-level recommendations. Therefore, we drafted consensus statements to address many clinical questions regarding pharmacotherapy for patients with PAH. A total of 79 recommendations or consensus statements were adopted and graded.
  
  
  CONCLUSIONS
  Clinical decisions regarding pharmacotherapy for PAH should be guided by high-level recommendations when sufficient evidence is available. Absent higher level evidence, consensus statements based upon available information must be used. Further studies are needed to address the gaps in available knowledge regarding optimal pharmacotherapy for PAH.
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Taichman
authors.affiliation: CHEST, Glenview, IL. Electronic address: jornelas@chestnet.org.
authors.forename: Joe
authors.initials: J
authors.lastname: Ornelas
authors.affiliation: Stanford University and Palo Alto VA Health Care System, Palo Alto, CA.
authors.forename: Lorinda
authors.initials: L
authors.lastname: Chung
authors.affiliation: Brown University, Providence, RI.
authors.forename: James R
authors.initials: JR
authors.lastname: Klinger
authors.affiliation: CHEST, Glenview, IL.
authors.forename: Sandra
authors.initials: S
authors.lastname: Lewis
authors.affiliation: University of California, San Diego, CA.
authors.forename: Jess
authors.initials: J
authors.lastname: Mandel
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Palevsky
authors.affiliation: University of Chicago, Chicago, IL.
authors.forename: Stuart
authors.initials: S
authors.lastname: Rich
authors.affiliation: Ohio State University, Columbus, OH.
authors.forename: Namita
authors.initials: N
authors.lastname: Sood
authors.affiliation: Columbia University Medical Center, New York, NY.
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rosenzweig
authors.affiliation: Yale University, New Haven, CT.
authors.forename: Terence K
authors.initials: TK
authors.lastname: Trow
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Rex
authors.initials: R
authors.lastname: Yung
authors.affiliation: Intermountain Medical Center and the University of Utah, Murray, UT.
authors.forename: C Gregory
authors.initials: CG
authors.lastname: Elliott
authors.affiliation: University of Colorado, Denver, CO.
authors.forename: David B
authors.initials: DB
authors.lastname: Badesch
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D032921:Consensus; D003697:Delphi Technique; D065627:Familial Primary Pulmonary Hypertension; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000959:Antihypertensive Agents