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Pulmonary hypertension is a condition that has a multitude of causes. Left untreated, patients with pulmonary hypertension will experience progressive symptoms of dyspnea and right heart failure resulting in significant morbidity and mortality. This review details the many evolving aspects of understanding related to pulmonary hypertension including signs and symptoms, pathophysiology, classification, anesthetic management including perioperative considerations and treatment options.Relatively new pharmacological agents developed through translatable animal research over the past few decades have broadened the therapeutic options for clinicians attempting to manage the difficult symptoms related to pulmonary hypertension. Currently available drugs utilized in the management of these complex patients are discussed in this review.Coupled with aggressive use of improved diagnostic hemodynamic monitors perioperatively, these patients can be medically optimized during their hospitalization and possibly aid in improving their long-term prognosis.