The understanding of pulmonary hypertension (PH) continues to evolve. The threshold to diagnose PH was lowered to mPAP ≥ 20 mmHg in the 6^th World Symposium on PH in 2018. The therapeutic approach has also changed over time, favoring aggressive use of multiple pulmonary vasodilators in combination upfront and escalation of therapy based frequent assessment of disease progression. The changes to diagnostic criteria and management underscore the need to identify the disease early and to treat it aggressively.