The 2026 TSOC Pulmonary Hypertension (PH)
guidelines introduce critical shifts that directly impact our management of
connective tissue disease-associated PAH (CTD-PAH). The lowered hemodynamic
threshold (mPAP > 20 mmHg, PVR > 2 WU) means more Systemic Sclerosis
(SSc) and SLE patients will cross the diagnostic line earlier. While
cardiologists may advocate for the swift initiation of PAH-targeted therapies,
we must critically evaluate the risk-benefit ratio. Premature exposure to
costly vasodilators in multi-morbid CTD patients is not always the optimal
first move.