Hypoxic pulmonary hypertension (HPH) is a key pathophysiological change in chronic pulmonary heart disease and various types of high-altitude diseases,which can ultimately lead to right ventricular failure and even death.Its pathogenesis mainly includes hypoxic pulmonary vasoconstriction and pulmonary vascular remodeling.Pulmonary arterial smooth muscle cells (PASMCs) are the main arterial cells that constitute the pulmonary artery wall,and their hypertrophy and proliferation are significant pathological features of HPH structural remodeling. Therefore,exploring the proliferative status of PASMCs is a core research area in pulmonary vascular structural remodeling.The glucose - 6- phosphate dehydrogenase (G6PD) pathway has emerged as one prominent focus both domestically and internationally. Intervening in PASMCs remodeling in HPH by inhibiting G6PD can reverse HPH. To better understand the relationship between the pathogenesis of HPH and the G6PD pathway, this review focuses on the research progress concerning the role of G6PD in regulating hypoxia-induced metabolic shifts and proliferation in PASMCs. The aim is to provide novel perspectives for the clinical treatment of HPH.