Stylized heart with interconnected pulmonary arteries and ventricles, symbolizing PH and HCM.

Pulmonary Hypertension in Hypertrophic Cardiomyopathy: What You Need to Know

Samir D’Costa in Health & Wellness December 2025 • 3 min read.

"Unveiling the significance of pulmonary hypertension in hypertrophic cardiomyopathy, especially for women and older adults."

Hypertrophic cardiomyopathy (HCM), a prevalent hereditary cardiac condition, involves the thickening of the left ventricle and/or septum, independent of other cardiac ailments. HCM manifests differently, ranging from asymptomatic states to severe conditions requiring immediate medical intervention. Classified into obstructive and non-obstructive types, its primary diagnosis relies on echocardiography.

While HCM predominantly affects the left heart, pulmonary hypertension (PH) emerges as a frequent complication. Although PH’s presence in HCM has long been acknowledged, recent studies have shed light on its clinical importance, underlying mechanisms, and prognostic implications. These studies highlight the increased risk of thromboembolism, atrial fibrillation, and heart failure in HCM patients with PH.

This review examines the prevalence, mechanisms, and effects of PH in HCM, offering a comprehensive look at how these conditions interact and impact patient outcomes.

What Are the Key Risk Factors Linking Pulmonary Hypertension and Hypertrophic Cardiomyopathy?

Stylized heart with interconnected pulmonary arteries and ventricles, symbolizing PH and HCM.

Recent research has pinpointed several key risk factors associated with the development of pulmonary hypertension in individuals with hypertrophic cardiomyopathy. A study by Wu et al. (2016), which involved 301 HCM patients, revealed that approximately 12% also had PH. The study further identified several independent risk factors:

Female Gender: Women are more likely to develop PH in the presence of HCM.
Age 65 Years and Older: Advanced age increases the risk.
Moderate to Severe Mitral Regurgitation: The severity of mitral valve leakage contributes to the likelihood of developing PH.
Atrial Fibrillation: Irregular heart rhythm is a significant risk factor.

The study emphasized that these factors independently elevate the risk of PH in HCM patients. Further analysis indicated that while age and mitral regurgitation were significant risk factors in men, atrial fibrillation and mitral regurgitation were more influential in women. This nuanced understanding helps in tailored risk assessment and management.

The Future of Managing PH in HCM

In summary, individuals with HCM who are older, female, and have atrial fibrillation or significant mitral regurgitation face a higher risk of developing PH. Addressing these factors through targeted interventions and continuous monitoring is crucial. Further research into the pathophysiology of PH in HCM is essential to refine treatment strategies and improve patient outcomes.

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Everything You Need To Know

What exactly is hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy (HCM) is a hereditary cardiac condition characterized by the thickening of the left ventricle and/or septum, independent of other cardiac ailments. This thickening can lead to various symptoms, ranging from being asymptomatic to causing severe conditions that require immediate medical intervention. HCM is typically diagnosed using echocardiography and is classified into obstructive and non-obstructive types based on whether the thickened heart muscle obstructs blood flow.

Why is pulmonary hypertension a concern for people who have hypertrophic cardiomyopathy?

Pulmonary hypertension (PH) is a frequent complication in patients with hypertrophic cardiomyopathy (HCM). PH involves high blood pressure in the pulmonary arteries, affecting blood flow from the heart to the lungs. While HCM primarily affects the left side of the heart, PH impacts the pulmonary vascular system, leading to increased strain on the right side of the heart. The co-existence of PH in HCM patients is associated with increased risks of thromboembolism, atrial fibrillation, and heart failure, making its management crucial for overall patient outcomes.

What are the main things that increase the chances of getting pulmonary hypertension if you already have hypertrophic cardiomyopathy?

Several risk factors increase the likelihood of developing pulmonary hypertension (PH) in individuals with hypertrophic cardiomyopathy (HCM). These include being female, age 65 years and older, having moderate to severe mitral regurgitation, and experiencing atrial fibrillation. These factors independently elevate the risk of PH in HCM patients. For instance, age and mitral regurgitation are significant risk factors in men, whereas atrial fibrillation and mitral regurgitation are more influential in women, highlighting the importance of tailored risk assessment and management strategies.

How does a leaky mitral valve affect the risk of pulmonary hypertension in hypertrophic cardiomyopathy?

Mitral regurgitation, particularly when moderate to severe, is a significant risk factor for pulmonary hypertension (PH) in individuals with hypertrophic cardiomyopathy (HCM). Mitral regurgitation refers to the leakage of blood backward through the mitral valve, which separates the left atrium and left ventricle. This leakage can increase pressure in the left atrium and subsequently in the pulmonary veins, leading to pulmonary hypertension. Managing mitral regurgitation is crucial in HCM patients to reduce the risk of developing PH and its associated complications.

What is the future of managing pulmonary hypertension in people with hypertrophic cardiomyopathy?

Managing pulmonary hypertension (PH) in patients with hypertrophic cardiomyopathy (HCM) involves addressing the key risk factors through targeted interventions and continuous monitoring. Further research into the pathophysiology of PH in HCM is essential to refine treatment strategies and improve patient outcomes. By understanding the mechanisms and effects of PH in HCM, healthcare professionals can develop more effective approaches to mitigate risks and enhance the quality of life for affected individuals. Future strategies may include novel drug therapies or interventions tailored to specific patient profiles and risk factors.