Pulmonary arterial hypertension (PAH) is a clinical syndrome that is often diagnosed late and is associated with a progressive clinical deterioration and death. However, over the past ten years there has been a dramatic increase in the number of effective therapies. Identification of dysfunctional pathways in the pulmonary circulation provided novel therapeutic targets with the goal of reducing pulmonary vascular resistance and death from right ventricular failure. Treatment strategies are determined according to current guidelines. Pulmonary artery vasoreactivity, functional class and response to treatment are important concepts for initiation of medical therapy. With the availability of medications that target different pathologic processes, combination therapy has become a frequently used therapeutic option in PAH. In this paper, we aimed to review the therapeutic algorithms in pulmonary hypertension based on current guidelines.