Maron BA, Brittan EL, Hess E, et al. - Given the association of elevated pulmonary vascular resistance (PVR) of 3·0 Wood units or more with poor prognosis in pulmonary hypertension subgroups, researchers sought to determine the correlation between PVR and adverse clinical outcomes in pulmonary hypertension. From the US Veterans Affairs health-care system (Oct 1, 2007–Sep 30, 2016), they included 40,082 patients who underwent right heart catheterisation (RHC), 38,751 [96·7%] male; median age 66·5 years [IQR 61·1–73·5]; median follow-up 1153 days [IQR 570–1971]. Patients at risk for pulmonary hypertension based on a mPAP of at least 19 mm Hg (32,725 [81·6%] of 40,082) were the focus of this study. They noted increase in all-cause mortality hazard for PVR at around 2·2 Wood units vs PVR of 1·0 Wood unit. When comparing PVR of 2·2 Wood units or more with less than 2·2 Wood units, the adjusted hazard ratio (HR) for mortality was 1·71 and for heart failure hospitalisation was 1·27 among patients with a mPAP of at least 19 mm Hg and pulmonary artery wedge pressure of 15 mm Hg or less. Data overall expanded the continuum of clinical risk for mortality and heart failure in cases referred for RHC with increased pulmonary artery pressure to include PVR of around 2.2 Wood units and higher.