FIGURE 3.

Initial management of pulmonary arterial hypertension in the current era. Based on our clinical experience, the majority of patients in the low- and intermediate-risk categories should be started on dual therapy with an endothelin receptor antagonist (ERA) plus a phosphodiesterase-5 inhibitor (PDE-5i) or soluble guanylate cyclase (sGC) stimulator. A small proportion of patients in the low-risk category may be suitable for monotherapy. For all patients who are in the high-risk category, combination therapy including an i.v. prostanoid is required.