European Respiratory Society clinical practice guidelines update for the treatment of pulmonary arterial hypertension
Presented at ERS 2026 in Barcelona, this update does not redraw the 2022 ESC/ERS document. It answers the two questions the last three years put to it: what to do with sotatercept, and when to put a catheter back into a patient who is already on treatment. Add-on sotatercept is recommended for patients on PAH therapy who remain at intermediate-low, intermediate-high or high risk of death, on a high certainty of evidence; at low risk the task force gives no recommendation, because the randomised trials enrolled too few such patients to answer for them. Treatment belongs in a pulmonary hypertension centre, with regular follow-up and appropriate monitoring. Right heart catheterisation during follow-up is suggested for the same intermediate-to-high risk groups when a therapeutic consequence is expected, and again withheld at low risk, there on very low certainty. Four PICO questions and one narrative question, GRADE throughout. The trials behind the sotatercept recommendation will be listed here once the journal deposits the guideline's reference list.
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