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Classes of Pulmonary Hypertension

Medically reviewed by Steven C. Pugliese, M.D.
Written by Kelly Crumrin
Updated on June 2, 2023

The World Health Organization (WHO) has developed a system of functional classes to describe the severity of pulmonary hypertension (PH) cases. Knowing what type and functional class of PH you have helps doctors decide which PH treatments will be most effective. One goal of treatment is to improve your functional class number. Progressing to a more severe functional class indicates that your current treatment is not working. You and your doctor can work together to modify your treatment plan.

Functional Classes of Pulmonary Hypertension

The WHO organizes PH into four classes based on the severity of PH symptoms, especially the limitations PH imposes upon daily activities.

Pulmonary Hypertension Class 1

People with class 1 pulmonary hypertension do not experience any PH symptoms, either at rest or with exercise.

Pulmonary Hypertension Class 2

Pulmonary hypertension is considered class 2 when a person experiences no PH symptoms at rest but feels uncomfortable and short of breath during their usual daily activities.

Pulmonary Hypertension Class 3

Someone with class 3 pulmonary hypertension may or may not experience symptoms at rest. Normal household chores and other daily activities are limited by extreme fatigue and shortness of breath. Symptoms may necessitate frequent breaks to rest.

Pulmonary Hypertension Class 4

In class 4 pulmonary hypertension, people experience symptoms at rest and during activity. Fainting is possible, especially when bending over. Edema (swelling) in the feet and ankles is common.

Your health care team can help you assess which functional class of PH you have. Even if you aren’t experiencing symptoms, it’s important to seek treatment to keep your PH from progressing to the more severe classes.

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Updated on June 2, 2023
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Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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