Heritable forms of pulmonary arterial hypertension

Semin Respir Crit Care Med. 2013 Oct;34(5):568-80. doi: 10.1055/s-0033-1355443. Epub 2013 Sep 13.


Tremendous progress has been made in understanding the genetics of heritable pulmonary arterial hypertension (HPAH) since its description in the 1950s. Germline mutations in the gene coding bone morphogenetic receptor type 2 (BMPR2) are detectable in the majority of cases of HPAH, and in a small proportion of cases of idiopathic pulmonary arterial hypertension (IPAH). Recent advancements in gene sequencing methods have facilitated the discovery of additional genes with mutations among those with and without familial PAH (CAV1, KCNK3). HPAH is an autosomal dominant disease characterized by reduced penetrance, variable expressivity, and female predominance. These characteristics suggest that genetic and nongenetic factors modify disease expression, highlighting areas of active investigation. The reduced penetrance makes genetic counseling complex, as the majority of carriers of PAH-related mutations will never be diagnosed with the disease. This issue is increasingly important, as clinical testing for BMPR2 and other mutations is now available for the evaluation of patients and their at-risk kin. The possibilities to avoid mutation transmission, such as the rapidly advancing field of preimplantation genetic testing, highlight the need for all clinicians to understand the genetic features of PAH risk.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Activin Receptors, Type II / genetics
  • Antigens, CD / genetics
  • Bone Morphogenetic Protein Receptors, Type II / genetics*
  • Caveolin 1 / genetics
  • Endoglin
  • Familial Primary Pulmonary Hypertension
  • Female
  • Gene-Environment Interaction
  • Genetic Counseling
  • Genetic Testing
  • Germ-Line Mutation
  • Humans
  • Hypertension, Pulmonary / epidemiology
  • Hypertension, Pulmonary / genetics*
  • Hypertension, Pulmonary / prevention & control
  • Male
  • Nerve Tissue Proteins / genetics
  • Penetrance
  • Potassium Channels, Tandem Pore Domain / genetics
  • Pregnancy
  • Preimplantation Diagnosis
  • Receptors, Cell Surface / genetics
  • Sex Distribution
  • TGF-beta Superfamily Proteins / genetics


  • Antigens, CD
  • CAV1 protein, human
  • Caveolin 1
  • ENG protein, human
  • Endoglin
  • Nerve Tissue Proteins
  • Potassium Channels, Tandem Pore Domain
  • Receptors, Cell Surface
  • TGF-beta Superfamily Proteins
  • potassium channel subfamily K member 3
  • ACVRL1 protein, human
  • Activin Receptors, Type II
  • BMPR2 protein, human
  • Bone Morphogenetic Protein Receptors, Type II