Pulmonary arterial hypertension (PAH) is a severe and progressive disease with limited survival prospects under currently available therapies. Since the 2022 edition of the European Society of Cardiology and European Respiratory Society guidelines on pulmonary hypertension, substantial clinical evidence has emerged, supporting a new treatment algorithm for PAH as presented at the 7th World Symposium on Pulmonary Hypertension 2024 and the following proceeding papers. Key updates include the introduction of sotatercept as a second-line therapy leading to a revised definition of maximal medical therapy now encompassing agents from four therapeutic groups (phosphodiesterase-5 inhibitors/soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin pathway agents, and sotatercept), instead of three (phosphodiesterase-5 inhibitors/soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin pathway agents). Other novelties include the elimination of a distinct pathway for patients with cardiopulmonary comorbidities in favor of an individualized approach, a reduction in the initial patient assessment risk categories from three to two, and a follow-up interval shortened from 3-6 months to 3-4 months post-treatment initiation. This review presents these advancements and emphasizes the need for their widespread implementation in clinical practice. At the end, we present new opportunities and challenges in the treatment of pulmonary arterial hypertension in eight Central and Eastern European countries.

'Carol Davila' University of Medicine and Pharmacy Bucharest Romania

Clinical Department of Cardiology and Angiology General University Hospital Prague Czech Republic

Department for Respiratory Diseases Jordanovac University Hospital Centre Zagreb Zagreb Croatia

Department of Cardiology 'Prof Dr C C Iliescu' Emergency Institute for Cardiovascular Diseases Bucharest Romania

Department of Cardiology and Angiology Faculty of Medicine Slovak Medical University and National Institute of Cardiovascular Diseases Bratislava Slovakia

Department of Cardiology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Department of Pulmonary Diseases and Allergy Ljubljana University Medical Center Ljubljana Slovenia

Institute of Cardiology Lithuania University of Health Sciences Kaunas Lithuania

Pulmonary Circulation Center Department of Cardiac and Vascular Diseases Jagiellonian University Medical College Kraków Poland

Rare Diseases Unit VSIA Pauls Stradins Clinical University Hospital Riga Stradiņš University Riga Latvia

School of Medicine University of Zagreb Zagreb Croatia

St John Paul 2 Hospital Kraków Poland

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