The most likely cause is long standing heart valve problems. If no cause of the hypertension can be found the diagnosis of primary pulmonary hypertension is made. The treatment of pulmonary hypertension is difficult. Vasodilator drugs such as calcium channel blockers can be used. Nitric oxide lowers PA pressure but only lasts for a very short time.
Anticoagulation is recommended for patients with blood clots.
For patients who fail to respond to medical therapy the only option is lung transplantion. If you would like to see someone at the Cleveland Clinic I would recommend Dr. Wiederman, the head of the department. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.