Pulmonary Artery Pressure Guidelines

Definition and Normal Values

The normal mean pulmonary arterial pressure at rest is 14 ± 3 mmHg with an upper limit of normal of approximately 20 mmHg 1, 2, 3
Normal mPAP at rest is 14 ± 3 mmHg 1, 3
The upper limit of normal for mPAP is approximately 20 mmHg 2, 3
Pulmonary hypertension is defined as mPAP ≥ 25 mmHg at rest as measured by right heart catheterization 2, 3
Recent guidelines have updated the threshold for pulmonary hypertension to mPAP > 20 mmHg based on the upper limit of normal pulmonary artery pressure in healthy individuals 4, 5

In healthy individuals, the average pulmonary artery systolic pressure measured by right heart catheterization is approximately 21 ± 4 mmHg 5, 6
The upper limit of normal PASP is around 30 mmHg 4, 6
On echocardiography, estimated PASP (ePASP) > 30 mmHg is generally outside the normal range in most healthy individuals 4, 6

Even mild elevations in pulmonary artery pressure (mPAP 20-24 mmHg) are associated with increased mortality 4, 5
ePASP >30 mmHg on echocardiography is present in over 40% of clinical echocardiograms and is associated with a five-year mortality of 25-40% 4, 5
The mortality risk rises by about 40% with every 10 mmHg increase in PA systolic pressure 5

PASP can be estimated non-invasively using echocardiography by measuring the velocity of the tricuspid regurgitation jet 4, 6
Absence of a measurable tricuspid regurgitation jet does not rule out elevated pulmonary artery pressure 5

The mean pulmonary artery pressure (mPAP) in healthy adults at rest is 14 ± 3 mmHg, establishing the physiological baseline measured by right‑heart catheterization. 7, 8
The upper limit of normal for resting mPAP is approximately 20 mmHg (mean + 2 SD), delineating normal from abnormal values. 7, 8
mPAP values 21–24 mmHg are considered a “gray zone” with uncertain clinical significance, but emerging data associate even mild elevation with increased mortality risk. 8

Pulmonary hypertension is formally defined as a resting mPAP ≥ 25 mmHg measured by right‑heart catheterization; this cutoff is used in all randomized controlled trials and registries. 7, 8, 9
Recent guideline proposals suggest lowering the diagnostic threshold to mPAP > 20 mmHg based on the statistical upper limit of normal, although the 25 mmHg cutoff remains the established clinical standard. 8

All hemodynamic reference values are obtained at rest in stable clinical conditions. 7, 8

Current evidence does not support a specific definition of exercise‑induced pulmonary hypertension; the historic criterion of mPAP > 30 mmHg during exercise is not validated, as healthy individuals can exceed this value during exertion. 7, 8, 9