Pulmonary hypertension is a constellation of diseases that shares signs and symptoms of dyspnea, fatigue, chest pain, palpitations, and syncope. Research advances made over the past decade have significantly changed the natural history of this disease. Therapies initially designed to specifically target the molecular causes of increased pulmonary vascular resistance are now used in all types of patients with pulmonary hypertension. The challenge of the primary care physician is first, identifying pulmonary hypertension, and second, determining the modifiable substrates that contribute to the development and symptoms of this disease.