On Tuesday STAT reported on a mystery patient with obesity, sleep apnea, and pulmonary hypertension who’d received an obesity drug not yet approved by federal drug regulators. The identity of the 79-year-old who won access in April to the Eli Lilly experimental drug retatrutide under a compassionate use program — typically reserved for people who are terminally ill — is still unknown.
But the report has raised interest in pulmonary hypertension. Given the unusual circumstances of the application, STAT had asked the White House if the patient was President Trump. After initially demurring, a spokesman said after publication that the drug was not for the president.
STAT asked medical experts to explain what pulmonary hypertension is and whether they think the newest class of obesity drugs might help. There’s no easy answer, they said, in part because “pulmonary hypertension” is an umbrella term covering vastly different disease states, with different causes and treatments.
“Pulmonary hypertension is nothing more than elevated blood pressure in the blood vessels of the lungs,” Paul Forfia, who directs the Emory Healthcare Pulmonary Hypertension, Right Heart Failure and CTEPH Program, told STAT. “That can be something that is very serious and life-threatening and life-altering, or it can be a whole lot of nothing, depending on the type of pulmonary hypertension that someone has.”
Some background on the GLP-1 angle: This class of obesity drugs, originally developed to treat type 2 diabetes, works well not only for weight loss but also for cardiovascular disease, metabolic illnesses, and the adjacent sleep apnea and kidney disorders. So it’s not a stretch to think they might also be helpful in some types of pulmonary hypertension, a form of high blood pressure found in blood vessels of the lung.
“I think because the GLP-1s can help with inflammation and stress on the heart from obesity and metabolic syndrome, they may be helpful in pulmonary hypertension due to any cause, but especially in patients who have pulmonary hypertension due to heart failure with preserved ejection fraction, where they have been well studied,” Vallerie McLaughlin, director of the pulmonary hypertension program at the University of Michigan, told STAT.
In heart failure with preserved ejection fraction (abbreviated as HFpEF), the heart pumps normally but is too stiff to fill properly. GLP-1s have been shown to lower the risk of complications and improve symptoms in people with this form of heart failure.
Research on pulmonary hypertension and GLP-1s isn’t advanced enough to make a solid conclusion, McLaughlin and others said, but some studies are in the works.
A September 2025 preprint from a Vanderbilt University team published on medRxiv (so not peer-reviewed) found an association between GLP-1 use and lower risk of pulmonary hypertension in a large, retrospective study of U.S. veterans with type 2 diabetes. A May 2025 review appearing in the American Heart Journal Plus: Cardiology Research and Practice called for prospective trials to confirm such a link.
What’s clear is that obesity aggravates matters.
“What happens is the patient becomes far more sick in the context of any given level of pulmonary hypertension in the context of the added problems of obesity, particularly when the person is morbidly obese,” Forfia said. “When a person is sufficiently obese, they literally can’t properly breathe, get oxygen into their bloodstream, get carbon dioxide out of their bloodstream.”
What is pulmonary hypertension?
Pulmonary hypertension is high blood pressure in the lungs. The progressive disorder can come both before and after heart failure, or it can follow a variety of conditions, including congenital heart disease, autoimmune conditions like connective tissue disease, coronary artery disease, high blood pressure, liver disease (cirrhosis), blood clots to the lungs, or chronic lung diseases like emphysema.
High blood pressure in the lungs makes the heart work harder to pump blood to the lungs. Heart failure can ensue, meaning lower pumping power throughout the rest of the body.
What are the symptoms?
The most common symptoms may not seem dramatic at first: shortness of breath after exertion, lightheadedness, fatigue, or chest pain. If it’s advanced, people might pass out or have signs of heart failure. When the heart’s right ventricle is failing, blood can back up into the legs and the belly, along with fluid overload and symptoms of right heart failure.
How common is it?
Pulmonary hypertension affects approximately 1% of the world population, or about 82 million people. It’s more common in women, non-Hispanic Black people, and people aged 75 or older. There are five different kinds, some more rare than others.
- Group 1 is pulmonary arterial hypertension, a rare and severe version that occurs when blood vessels in the lungs narrow and stiffen. Patients might be women in their 30s with an autoimmune disease like lupus or people of any age exposed to such toxins as methamphetamines or, in the past, the fen-phen appetite suppressant drug of the 1990s, later withdrawn after being linked to heart disease.
- Group 2 is the most common, affecting about 60% of patients. Their hearts don’t squeeze or relax properly, or their valves on the left side of the heart have problems, causing a backup of blood that raises pressure in the lungs.
- Group 3 comes from chronic lung diseases like emphysema or COPD.
- Group 4 arises from chronic blood clots in the lungs.
- Group 5 is the catch-all for other underlying disease causes, from sickle cell anemia to thyroid disease to chronic kidney failure.
What treatments work?
Surgery, catheter-based options, and medical therapy can treat group 4’s chronic blood clots in the lung, followed by lifetime use of blood thinners. “It is arguably the only form of pulmonary hypertension that can be cured,” Forfia of Emory said. “Removal of chronic blood clots from the lungs can lead to complete resolution of the pulmonary hypertension.”
For group 1’s pulmonary arterial hypertension, there are now 17 drugs developed over the last 25 years that can ease symptoms and prolong life.
For the other groups, drugs to treat the underlying cause can be the answer. Michigan’s McLaughlin noted that the 79-year-old in question who received retatrutide had three factors that may be interrelated: sleep apnea, obesity, and pulmonary hypertension.
When an extreme form of sleep apnea is combined with obesity, people might not breathe normally. That airflow obstruction sends oxygen levels plummeting, stimulating the pulmonary arteries to squeeze. That can cause pulmonary hypertension via a syndrome called obesity hypoventilation.
“I don’t know the details of that case, but because there are so many different things that can cause pulmonary hypertension, it may have contributed to some of those underlying causes,” McLaughlin said about obesity hypoventilation syndrome.
Can GLP-1 drugs help?
It depends. Roxana Sulica, director of the pulmonary hypertension program at NYU Langone Health, said she’d like to rename pulmonary hypertension to distinguish group 1 people with the arterial form of the disease from the much larger group 2, with cardiometabolic conditions.
“For people with a combination of health problems that we all suffer as we get old — the obesity, diabetes, sleep apnea — maybe for these people, all these weight loss drugs would be great,” she said. “They would directly benefit from treating the root of the evil.”
Forfia recalled how patients on GLP-1s who lose large amounts of weight tell him they feel. They say they can walk farther, faster, with less effort.
“That makes sense, right? Because it’s less metabolically costly for you to move your body when your body is lighter,” he said. “But it’s not just a subjective improvement. You will see that fluid retention and cardiac failure on their labs will resolve and reverse. You’ll often see that the amount of diuretics that a patient requires, which is the medicines that help make them pee off extra fluid, will drop dramatically.”
McLaughlin said she thinks there’s a scientific rationale for GLP-1s potentially helping resolve some of the underlying mechanisms behind pulmonary hypertension.
“A lot of the metabolic syndrome — obesity, heart failure with preserved ejection fraction, sleep apnea — a lot of those things travel together,” she said. “I think those drugs do a lot of different things, in addition to weight loss and reduced inflammation.”
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