Here's my experience with pulmonary hypertension, seems it was correctly called by my cardiologist as being caused by left diastolic dysfunction- as he explained it strain on my heart over the years from various risk factors, ie, chronic hard to control hypertension, being overweight, as well as other factors such as genetics. CT scans on my chest ( for cancer surveillance) showed an enlarged pulmonary artery at the base, suggestive of pulmonary hypertension and two echocardiograms showed pulmonary pressures of 65 and 58 mm/Hg, respectively. I had no symptoms I could say was due to this condition, except for some peripheral edema, I also have paroxysmal A-fib and other issues that occasional tiredness and shortness of breath could be blamed on, but no lung issues. The cardiologist prescribed a fairly low dose of furosemide ( 20 mg/day) and that took care of the edema and I just felt better. I continued the furosemide, and the cardiologist ordered another echo which I had done in February, this time the pulmonary artery pressure was within the normal range at 34 mm/Hg ( normal less than 35). I also had noted my blood pressure was consistently within the normal range with the addition of the furosemide to my medication list.

The cardiologist had emphasized lifestyle measures ( weight control, exercise, exercise, exercise and blood pressure control) as the best way to ensure as good as possible heart health. I'd seen him before the third echo showing the normal pulmonary pressure and he had instructed me to continue all the medication I was taking including the furosemide- which is ok with me as I've taken it all so long I am used to it. During my cardiac visit we discussed the other medications used for pulmonary hypertension and he said for patients who have shortness of breath and other symptoms from pulmonary hypertension due to diastolic dysfunction he prescribed sildenafil and they found that was helpful. We decided I didn't need it as I'm not really symptomatic. We were fine with just the furosemide, and my PCP ( who I saw after the 3rd echo) suggested I keep taking the furosemide as long as my kidney function remains good- it certainly seems to help with things. And it looks as though I don't need a RHC, thank goodness!

I hadn't read anything about using Jardiance or any of the other SGLT-2 inhibitors for diastolic dysfunction or other heart failure, though I now see there some emerging studies for their use in patients with pulmonary hypertension Type II- associated with right or left-sided heart failure, but that still looks to me to be a work in progress. I might caution someone using these drugs to be aware of the side effects that can occur from these drugs, in particular the development of a perianal abscess that can lead to necrotizing fasciitis, sepsis and death if not treated as soon as possible. This happened to my brother, who was taking one of these drugs for his diabetes and also had heart failure. I don't know if he was taking Jardiance or another one of the SGLT-2 inhibitor drugs, but apparently these side effects are particular to all of this type due to their mechanism of action. I think these side effects are rare, but they are certainly something to be aware of and to look out for for people using those drugs.