A prospective, randomised, controlled single-centre study looking at whether fluid restriction (FR) helps pulmonary arterial hypertension patients with right heart failure and signs of volume overload. 41 patients (average age 70, mostly World Health Organisation (WHO) Functional class III, were split between intensified fluid restriction counselling (around 1.5 litres per day) and routine fluid restriction advice, then followed for about 28 weeks.
Key finding: Both groups reduced their fluid intake by a similar amount (~0.57 L/day) — the intensified counselling didn’t outperform routine advice. But fluid restriction itself, achieved either way, produced meaningful improvements: right atrial size shrank significantly (though right ventricular size didn’t reach significance), and several secondary measures improved — systolic pulmonary artery pressure, left ventricular eccentricity index, quality of life (mental health and physical function), and symptom burden (PAH-SYMPACT questionnaire).
Bottom line: Fluid restriction to around 1.5 litres per day genuinely helps right heart size and clinical outcomes in pulmonary arterial hypertension patients with right heart failure — but standard clinical counselling is enough to get there; a more intensive educational push isn’t necessary to see the benefit.
Read more at this link on Respiration
Citation
Benjamin N, Hess V, Xanthouli P, Resag C, Egenlauf B, Heinz J, Grünig E, Harutyunova S. Randomised, controlled trial on fluid restriction in pulmonary arterial hypertension. Respiration. 2026 Sep 9:1. doi: 10.1159/res/aepag008. Epub ahead of print. PMID: 42715124.