Aim: We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension. Methods: The present study was conducted in department of radiology and 500 patients were included in the study. Patients with a CT scan within 90 days of MRI and RHC were included. In order to meet inclusion criteria, a diagnostic quality CT pulmonary angiogram (CTPA) with a slice thickness of less than 5 mm was required. Results: We included 500 scans from 500 patients; 300 (60%) had RHC-confirmed pulmonary hypertension, with mPAP ⩾25 mmHg. Compared with the non-pulmonary hypertension group, the group with pulmonary hypertension had greater MPAD, RPAD, LPAD and PA:Ao in both respiratory cycles, whereas the PA angle was greater in the nonpulmonary hypertension group. In the subgroup with pulmonary hypertension, the median MPAD was 34.60 mm in inspiration and 34.65 mm in expiration, while in the non-pulmonary hypertension group it was 30.00 mm in inspiration and 30.50 mm in expiration. For the cohort as a whole, the areas under the receiver operating characteristic curves (AUCs) for inspiratory MPAD and inspiratory PA:Ao (for RHC-confirmed pulmonary hypertension defined as Mpap ⩾25 mmHg) were 0.741 and 0.750, respectively. For the cohort as a whole, the cut-offs MPAD ⩾32.5 mm and PA:Ao ⩾0.94 yielded the most favourable diagnostic profiles. Conclusion: Findings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ⩾29 mm had high sensitivity and PA:Ao ⩾1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD