Overview of Methamphetamine-Associated Pulmonary Arterial Hypertension

Chest. 2024 Jun;165(6):1518-1533. doi: 10.1016/j.chest.2024.01.014. Epub 2024 Jan 9.


Topic importance: The global surge in methamphetamine use is a critical public health concern, particularly due to its robust correlation with methamphetamine-associated pulmonary arterial hypertension (MA-PAH). This association raises urgent alarms about the potential escalation of MA-PAH incidence, posing a significant and imminent challenge to global public health.

Review findings: This comprehensive review meticulously explores MA-PAH, offering insights into its epidemiology, pathophysiology, clinical presentation, diagnostic intricacies, and management strategies. The pathogenesis, yet to be fully described, involves complex molecular interactions, including alterations in serotonin signaling, reduced activity of carboxylesterase 1, oxidative stress, and dysregulation of pulmonary vasoconstrictors and vasodilators. These processes culminate in the structural remodeling of the pulmonary vasculature, resulting in pulmonary arterial hypertension. MA-PAH exhibits a more severe clinical profile in functional class and hemodynamics compared with idiopathic pulmonary arterial hypertension. Management involves a multifaceted approach, integrating pulmonary vasodilators, cessation of methamphetamine use, and implementing social and rehabilitation programs. These measures aim to enhance patient outcomes and detect potential relapses for timely intervention.

Summary: This review consolidates our understanding of MA-PAH, pinpointing knowledge gaps for future studies. Addressing these gaps is crucial for advancing diagnostic accuracy, unraveling mechanisms, and optimizing treatment for MA-PAH, thereby addressing the evolving landscape of this complex health concern.

Keywords: estrogen paradox; methamphetamine; methamphetamine-associated pulmonary arterial hypertension; pulmonary arterial hypertension; pulmonary hypertension.

Publication types

  • Review

MeSH terms

  • Amphetamine-Related Disorders / complications
  • Amphetamine-Related Disorders / physiopathology
  • Central Nervous System Stimulants / adverse effects
  • Humans
  • Hypertension, Pulmonary / chemically induced
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / physiopathology
  • Methamphetamine* / adverse effects
  • Pulmonary Arterial Hypertension* / chemically induced
  • Pulmonary Arterial Hypertension* / drug therapy
  • Pulmonary Arterial Hypertension* / physiopathology


  • Methamphetamine
  • Central Nervous System Stimulants