Hormone Replacement Therapy and Pulmonary Hypertension: A Review of the Literature

Pulmonary hypertension (PH) is a multifactorial condition that encompasses a group of diseases characterized by a progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and death. The primary goals of PH treatment are to lower pulmonary arterial pressure, alleviate symptoms such as shortness of breath and chest pain, address modifiable risk factors, and manage the underlying cause, often a common advanced disease like chronic obstructive lung disease or left heart disease. While sex is an unchangeable risk factor for PH development, the presence or absence of estrogens has a significant influence on its progression. Hormone replacement therapy (HRT) is the recommended form of estrogen therapy for postmenopausal women, but only in carefully selected cases. However, a paradox arises, as some research suggests HRT benefits women, while other studies highlight its risks. This review provides a comprehensive analysis of the literature on the role of HRT in PH.