Prevalence, pathogenesis, and clinical impact of pulmonary hypertension associated with chronic obstructive pulmonary disease

Pulmonary hypertension (PH) is a progressive condition associated with substantial morbidity and mortality. Chronic obstructive pulmonary disease (COPD), one of the leading global causes of death, frequently coexists with PH, further amplifying functional limitation, increasing exacerbation rates, and elevating mortality risk. Despite its high prevalence, PH-COPD remains under-recognized and lacks evidence-based treatment strategies. This review summarizes current knowledge on its prevalence, pathophysiology, and therapeutic approaches, with particular emphasis on the emerging concept of a "pulmonary vascular phenotype" in COPD. We discuss findings from epidemiological studies, clinical trials of targeted therapies, and registry data, highlighting both inconsistent results and safety concerns. Importantly, we present preliminary real-world data from a Brazilian referral center, which suggests a lower prevalence than previously reported. By integrating global and local perspectives, this review underscores the urgent need for refined phenotyping, biomarker development, and rigorously designed clinical trials to establish therapeutic strategies for this large and vulnerable population.