On Tuesday, STAT published a report about an unidentified patient suffering from obesity, sleep apnea, and pulmonary hypertension who received a new obesity drug, not yet approved by the federal drug regulators. The 79-year-old was granted access to Eli Lilly’s experimental drug retatrutide in April through a compassionate use program, generally designated for terminally ill individuals. The patient’s identity remains unknown.
The report has sparked interest in pulmonary hypertension. Due to the unusual nature of the application, STAT inquired with the White House to determine if the patient was President Trump. Initially, the White House did not confirm, but later a spokesperson clarified that the drug was not administered to the president.
STAT sought insights from medical experts about pulmonary hypertension and whether the latest obesity drugs might be beneficial. Experts explained that the term “pulmonary hypertension” encompasses a range of disease states with varying causes and treatments, making it difficult to provide a straightforward answer.
Paul Forfia, director of the Emory Healthcare Pulmonary Hypertension, Right Heart Failure and CTEPH Program, explained to STAT, “Pulmonary hypertension is simply elevated blood pressure in the lungs’ blood vessels. It can be very serious and life-threatening or trivial, depending on the type of pulmonary hypertension one has.”
GLP-1 drugs, initially developed for type 2 diabetes, are effective for weight loss and treating cardiovascular disease, metabolic illnesses, sleep apnea, and kidney disorders. Thus, it’s plausible they might aid certain types of pulmonary hypertension, which is a form of high blood pressure in lung vessels.
Vallerie McLaughlin, director of the pulmonary hypertension program at the University of Michigan, told STAT, “GLP-1s can help with inflammation and heart stress from obesity and metabolic syndrome. They might be useful in pulmonary hypertension due to any cause, especially in patients with pulmonary hypertension related to heart failure with preserved ejection fraction, where they have been thoroughly studied.”
In heart failure with preserved ejection fraction (HFpEF), the heart pumps normally but is too stiff to fill correctly. GLP-1s have demonstrated a reduction in complications and symptom improvement in individuals with this type of heart failure.
Research on the interaction between pulmonary hypertension and GLP-1s isn’t comprehensive enough to draw firm conclusions, according to McLaughlin and other experts, although studies are ongoing.
A preprint from Vanderbilt University researchers, published on medRxiv in September 2025, found a link between GLP-1 use and a reduced risk of pulmonary hypertension in a large retrospective study of U.S. veterans with type 2 diabetes. Meanwhile, a review in the American Heart Journal Plus: Cardiology Research and Practice in May 2025 highlighted the need for prospective trials to confirm this association.
Obesity clearly exacerbates the condition.
Forfia noted, “Patients become much sicker with any level of pulmonary hypertension when compounded by obesity, especially in cases of morbid obesity. When someone is significantly obese, they can’t breathe properly, impede oxygen intake, and carbon dioxide expulsion.”Â
Understanding Pulmonary Hypertension
Pulmonary hypertension, characterized by high blood pressure in the lungs, is a progressive disorder that can precede or follow heart failure, or arise from various conditions such as congenital heart disease, autoimmune disorders, coronary artery disease, high blood pressure, liver disease (cirrhosis), lung blood clots, or chronic lung diseases like emphysema.
High blood pressure in the lungs forces the heart to work harder to pump blood to the lungs, potentially leading to heart failure and reduced pumping capacity for the rest of the body.
Recognizing the Symptoms
The most common symptoms may initially appear mild, such as shortness of breath after exertion, lightheadedness, fatigue, or chest pain. In advanced cases, individuals might faint or show signs of heart failure. A failing right ventricle can cause blood to pool in the legs and abdomen, leading to fluid overload and right heart failure symptoms.
Prevalence of Pulmonary Hypertension
Pulmonary hypertension affects about 1% of the global population, or roughly 82 million people. It is more prevalent among women, non-Hispanic Black individuals, and those aged 75 or older. The condition has five distinct types, varying in rarity.
- Group 1, pulmonary arterial hypertension, is a rare and severe form occurring when lung blood vessels narrow and stiffen. Patients might include women in their 30s with autoimmune diseases like lupus, or individuals of any age exposed to toxins such as methamphetamines or, historically, the fen-phen appetite suppressant withdrawn in the 1990s after being linked to heart disease.
- Group 2, the most common type, affects about 60% of patients whose hearts struggle to squeeze or relax properly, or whose left heart valves are faulty, causing blood to back up and increase lung pressure.
- Group 3 arises from chronic lung diseases like emphysema or COPD.
- Group 4 results from chronic blood clots in the lungs.
- Group 5 encompasses other underlying disease causes, including sickle cell anemia, thyroid disease, and chronic kidney failure.
Effective Treatments
Surgery, catheter-based procedures, and medical therapy can treat Group 4’s chronic lung blood clots, followed by lifelong blood thinner use. According to Forfia of Emory, “It is arguably the only form of pulmonary hypertension that can be cured. Removing chronic blood clots from the lungs can completely resolve the condition.”
For Group 1’s pulmonary arterial hypertension, 17 drugs developed over the past 25 years can alleviate symptoms and extend life.
For other groups, addressing the underlying cause with medication can be effective. McLaughlin from Michigan highlighted that the 79-year-old patient who received retatrutide had three potentially interrelated factors: sleep apnea, obesity, and pulmonary hypertension.
In severe sleep apnea paired with obesity, individuals may not breathe normally, causing oxygen levels to drop and pulmonary arteries to constrict. This can lead to pulmonary hypertension through a syndrome known as obesity hypoventilation.
McLaughlin remarked, “I don’t know the specifics of that case, but given the myriad causes of pulmonary hypertension, it might have contributed to some of those underlying issues,” in reference to obesity hypoventilation syndrome.
Potential Benefits of GLP-1 Drugs
It varies. Roxana Sulica, director of the pulmonary hypertension program at NYU Langone Health, suggested renaming pulmonary hypertension to differentiate Group 1 individuals with the arterial form from the larger Group 2 with cardiometabolic conditions.
“For individuals with multiple health issues common with aging — obesity, diabetes, sleep apnea — these weight loss drugs might be ideal,” she stated. “They could directly address the root cause.”
Forfia recounted patients on GLP-1s who lose significant weight expressing how they feel. They report being able to walk longer distances faster and with less effort.
“That makes sense because it’s less metabolically demanding to move a lighter body,” he said. “But it’s not just a subjective improvement. Fluid retention and cardiac failure indicators in their lab results improve and reverse. The diuretic dosage needed to expel excess fluid often decreases significantly.”
McLaughlin believes there’s a scientific basis for GLP-1s potentially addressing some fundamental mechanisms behind pulmonary hypertension.
“Many elements of metabolic syndrome — obesity, heart failure with preserved ejection fraction, sleep apnea — frequently occur together,” she noted. “These drugs offer multiple benefits, beyond weight loss and reduced inflammation.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
