This module focuses on sustaining effective PAH management over time by integrating ongoing risk assessment with treatment persistence, tolerability, and evolving patient needs. It examines when continued therapy, escalation, transition, or carefully selected de-escalation may be appropriate, while emphasizing that failure to achieve or maintain low-risk status should prompt reassessment. The module also addresses adverse-effect mitigation, treatment burden, adherence, and the importance of avoiding abrupt discontinuation of PAH therapies, reinforcing a patient-centered approach that continually aligns treatment intensity with disease control and the patient's capacity to sustain therapy.

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This module explores how risk status, clinical trajectory, right ventricular function, hemodynamics, and patient-specific factors inform the selection and escalation of PAH therapy. It reviews therapies targeting the endothelin, nitric oxide, prostacyclin, and activin signaling pathways and considers how combination therapy and route of administration can be individualized according to disease severity and treatment goals. Particular emphasis is placed on balancing therapeutic efficacy with treatment burden, lifestyle, adherence, support systems, and the patient's ability to manage therapy through shared decision-making.

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This module examines structured risk assessment as the foundation for goal-directed management of pulmonary arterial hypertension (PAH), emphasizing that clinical stability is not synonymous with low-risk status. It reviews validated risk-stratification approaches and the integration of functional capacity, biomarkers, imaging, and hemodynamics to assess prognosis and treatment response. The module emphasizes routine reassessment and timely treatment modification when patients fail to achieve or maintain low-risk status, while also incorporating treatment burden and patient preferences into shared decision-making.

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