Which types of pulmonary hypertension can be fully reversed?
Some forms of pulmonary hypertension are entirely reversible when the underlying cause is treated. The clearest example is PH caused by severe vitamin C deficiency (scurvy). In a 2024 case report, two children with restrictive diets developed life-threatening PH, and their pulmonary artery pressures rapidly returned to normal after vitamin C supplementation [9]. This shows that when PH is driven by a specific, correctable nutritional deficiency, the condition can be completely reversed.
Chronic thromboembolic pulmonary hypertension (CTEPH), caused by old blood clots in the lungs, is another potentially curable form. A 2023 review states that CTEPH is "potentially curative with pulmonary thromboendarterectomy surgery," with mortality rates around 2% at expert centers [7]. This surgery physically removes the clots, allowing blood flow to normalize. However, not all patients are candidates for surgery, and even after successful surgery, other health issues like sleep apnea may persist [8].
Can pulmonary arterial hypertension (PAH) be reversed with medication?
For pulmonary arterial hypertension (PAH), the most studied form, the answer is more nuanced. PAH is a progressive disease involving the remodeling of blood vessels, and it is not considered curable with current medications. However, powerful new treatments can significantly reverse some of the damage. In a 2023 phase 3 trial of the drug sotatercept, patients on stable background therapy who received the drug walked an average of 34.4 meters further in six minutes after 24 weeks, compared to just 1.0 meter in the placebo group [3]. The drug also reduced pulmonary vascular resistance (a measure of how hard the heart has to work) and improved other key measures of disease severity [3]. An earlier phase 2 trial confirmed these findings, showing a significant drop in pulmonary vascular resistance [1].
It is important to understand that these improvements, while substantial, represent a reversal of some of the disease's effects, not a cure. The goal of treatment for PAH is to manage symptoms, improve quality of life, and slow disease progression. Other experimental drugs, like the TRPC6 blocker BI-749327, have shown the ability to reverse established PH by about 50% in mice by regressing vascular remodeling, but this is still in the preclinical stage [4]. Similarly, the drug halofuginone has been shown to partly reverse PH in mice by acting as a vasodilator and anti-proliferative agent [12].
What about PH caused by other conditions like lung disease or COVID-19?
When PH is caused by another underlying condition, such as chronic lung disease, the reversibility depends on treating that primary condition. For example, in patients with PH due to chronic obstructive pulmonary disease (COPD), a 2021 registry study found that those with severe PH who showed improvements in walking distance or functional class after starting PH medications had better outcomes [2]. However, the PH itself was not reversed, and these patients had a worse prognosis than those with PAH alone [2]. Similarly, in patients with systemic sclerosis (scleroderma) who have both PH and interstitial lung disease (ILD), treatment with PAH therapies improved hemodynamics but did not improve walking distance or functional class as much as in patients without ILD, and their survival was worse [6][11].
Even temporary conditions like COVID-19 can cause PH. A 2021 review notes that about 12-13% of hospitalized COVID-19 patients show signs of PH on echocardiogram, and that PH is associated with worse outcomes [10]. In these cases, PH may resolve as the infection clears, but specific data on long-term reversibility is not yet available. For newborns with persistent pulmonary hypertension of the newborn (PPHN), a systematic review found that ECMO (a life-support machine) can be life-saving, with a survival rate of 67.1%, but this is a treatment for a critical, often reversible, acute condition, not a chronic disease [5].
About These Sources
This answer is built on 12 peer-reviewed studies — published from 2019 to 2024, 2 from 2024 or later, 6 in Q1 journals, collectively cited 1,373 times — selected as the most relevant from 15 studies that passed quality screening, drawn from 65 papers retrieved from a database of over 500 million.
Sources used in this answer
Sotatercept for the Treatment of Pulmonary Arterial Hypertension
In a 24-week phase 2 trial, the drug sotatercept significantly reduced pulmonary vascular resistance in PAH patients on background therapy, with the higher dose showing a greater effect [2].
Pulmonary Hypertension in Patients With COPD
In a registry study, patients with PH due to COPD had worse survival than those with idiopathic PAH, but those with severe PH who improved on treatment had better outcomes [3].
Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension
In a phase 3 trial, sotatercept improved 6-minute walk distance by a median of 34.4 meters vs. 1.0 meter for placebo in PAH patients, and improved eight of nine secondary endpoints [4].
TRPC6, a therapeutic target for pulmonary hypertension
In a mouse study, the oral TRPC6 blocker BI-749327 reversed established PH by about 50% through regression of vascular remodeling [5].
International treatment outcomes of neonates on extracorporeal membrane oxygenation (ECMO) with persistent pulmonary hypertension of the newborn (PPHN): a systematic review.
A systematic review of neonates with PPHN on ECMO found a survival rate of 67.1%, with higher mortality linked to congenital diaphragmatic hernia and lower Apgar scores [6].
Hemodynamic Response to Treatment and Outcomes in Pulmonary Hypertension Associated With Interstitial Lung Disease Versus Pulmonary Arterial Hypertension in Systemic Sclerosis: Data From a Study Identifying Prognostic Factors in Pulmonary Hypertension Associated With Interstitial Lung Disease.
In a registry study, patients with PH and interstitial lung disease due to systemic sclerosis had worse survival and less functional improvement on PAH therapy than those with PAH alone [7].
Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension
A review states that chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable with pulmonary thromboendarterectomy surgery, with mortality around 2% at expert centers [8].
Chronic thromboembolic pulmonary hypertension: Reversal of pulmonary hypertension but not sleep disordered breathing following pulmonary endarterectomy.
In CTEPH patients, sleep-disordered breathing remained common even after successful pulmonary endarterectomy that resolved the PH, suggesting it is not solely caused by PH [11].
Reversible severe pulmonary hypertension related to scurvy in children
Two case reports describe children with severe PH due to scurvy (vitamin C deficiency) whose PH was rapidly and completely reversed with vitamin C supplementation [12].
Pulmonary Hypertension and COVID-19
A review reports that about 12-13% of hospitalized COVID-19 patients show signs of PH, which is associated with worse outcomes, and that inhaled vasodilators may be beneficial [13].
Prevalence, Treatment, and Outcomes of Coexistent Pulmonary Hypertension and Interstitial Lung Disease in Systemic Sclerosis.
In a cohort of patients with systemic sclerosis and ILD, 31.2% had PH, and 3-year survival after PH diagnosis was 91% with treatment [14].
Halofuginone, a promising drug for treatment of pulmonary hypertension
In a mouse study, the drug halofuginone partly reversed established PH by acting as a vasodilator and inhibiting cell proliferation [15].