First Issue of Indian Version of Advances in Pulmonary Hypertension

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As the first issue of the Indian edition of Advances in Pulmonary Hypertension is distributed to 500 physicians in India through the efforts of Wolters Kluwer Health and Cipla, PHA is pleased to provide the following commentary from the Indian editor, B. K. Srinivasa Sastry, Senior Consultant Cardiologist, CARE Hospitals, Hyderabad. Dr Sastry will provide four issues annually to the Indian healthcare community that include articles from each of the primary issues with ads from PHA about membership and online education opportunities. In future issues he will provide commentary on the contents, which we will post on the PHA website. The PHA Scientific Leadership Council and Advances editorial advisory board are delighted to be able to expand the reach of PHA internationally through this effort to help improve patient care throughout the world.

Pulmonary arterial hypertension continues to be a disease with poor outcome. Treatment options remain limited, especially in India where the majority of patients cannot afford a good standard of care. No systematic study is available to give the magnitude of incidence and prevalence, but prevalence probably is in the range of 5-6 per million. It is possible that some patients may remain undiagnosed since in many patients it may be wrongly treated as other diseases and a thorough work-up may not be done. Eisenmenger syndrome is likely to be seen more commonly than in the developed world since widespread paediatric cardiac surgical programs are not available. Similarly, pulmonary hypertension associated with rheumatic valvular heart disease is also more common. Some patients continue to have PH even after the correction of underlying valvular disease. In many patients, because of financial reasons as well as ignorance of treating physicians, work-up remains incomplete.

Until a decade ago, outcomes were very bleak. Currently available treatment options in India include sildenafil, tadalafil and bosentan. With the advent of these drugs, patients' survival has improved. Less expensive generic versions manufactured by the local pharmaceutical industry are available, although many patients find it difficult to afford even these. Intravenous epoprostenol, inhaled iloprost and treprostinil are not available in India. Not much experience is available in India with heart lung transplantation. More and more physicians including cardiologists, chest physicians, and rheumatologists are showing interest in the management of PAH patients, which is definitely having a favourable impact on patients' outcomes.

I am pleased to have been appointed editor of this new publication for the Indian healthcare community and look forward to its having a positive impact on PH patients in our country.

--BKS Sastry, MBBS, MD, DM