Usefulness of Beta-Blocker Therapy and Outcomes in Patients With Pulmonary Arterial Hypertension

• Published in: The American journal of cardiology 2012-05, Vol.109 (10), p.1504-1509
• Main Authors: So, Petsy Pui-Sze, MD, PhD, Davies, Ross A., MD, Chandy, George, MD, Stewart, Duncan, MD, Beanlands, Rob S.B., MD, Haddad, Haissam, MD, Pugliese, Carolyn, RN, Mielniczuk, Lisa M., MD
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - therapeutic use; Aged; Beta blockers; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Familial Primary Pulmonary Hypertension; Female; Follow-Up Studies; Heart failure; Heart Failure - etiology; Heart Failure - physiopathology; Heart Failure - prevention & control; Hospitalization; Humans; Hypertension; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - mortality; Male; Medical sciences; Middle Aged; Mortality; Ontario - epidemiology; Pneumology; Prospective Studies; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Pulmonary Wedge Pressure - drug effects; Risk Factors; Survival Rate - trends; Treatment Outcome; Vascular Resistance - drug effects; Ventricular Dysfunction, Right - complications; Ventricular Dysfunction, Right - physiopathology; Ventricular Dysfunction, Right - prevention & control; Ventricular Function, Right - drug effects
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.01.368

Pulmonary arterial hypertension (PAH) is a disorder in which pulmonary arterial remodeling and vasoconstriction progressively lead to right heart failure (HF), exercise intolerance, and high mortality. Beta-blockers have been shown to decrease mortality in left-sided HF, but their efficacy in isolated right HF associated with PAH is uncertain. Patients with PAH may have cardiac co-morbidities for which β-blocker therapy is indicated, and the relative risk benefit of this therapy remains to be proved. This is a prospective cohort study of 94 consecutive patients with PAH divided into 2 groups with and without β-blocker use at baseline. Rate of all-cause mortality, PAH-related hospitalization, change in 6-minute walk test, right ventricular structure and function measured by echocardiography, and hemodynamics measured by right heart catheterization were determined between subjects with and without β-blocker use. Beta-blocker use was common (28%) in this cohort. After a median follow-up of 20 months, changes in pulmonary hemodynamics and right ventricular size and function were similar between groups. There were no statistically significant differences in adverse events including PAH-related hospitalization or all-cause mortality (p = 0.19), presence of right HF by last visit (p = 0.75), or change in last 6-minute walk distance (p = 0.92). In conclusion, β-blocker use is not uncommon in a select group of patients with PAH and cardiac co-morbidities and did not appear to exert detrimental effects in clinical, functional, and hemodynamic outcomes. Further randomized data are needed to evaluate the potential benefits and risks of β-blocker use in patients with PAH.