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Viewpoint: a critique of pulmonary vascular resistance to define severe pulmonary hypertension ExtractIt has long been known that pulmonary hypertension (PH) associated with lung diseases and/or hypoxia may have a negative impact on functional state, exercise capacity, quality of life and survival [1]. While available data suggest a continuum of disease state with outcome, there has been a consensus among experts that a heart failure or “vascular” phenotype may predominate over background lung disease symptomatology, function and prognosis when PH is “severe” [1]. However, the definition of “severe PH” has evolved over time. In the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines, “severe PH” was defined by a mean pulmonary artery pressure (mPAP) >35 mmHg, or by an mPAP ≥25 mmHg with a cardiac index <2.5 L·min−1 [2, 3]. https://publications.ersnet.org/content/erj/65/6/2500409