title: Usefulness of beta-blocker therapy and outcomes in patients with pulmonary arterial hypertension.
abstract: 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.
authors.affiliation: University of Ottawa Heart Institute, Ontario, Canada.
authors.forename: Petsy Pui-Sze
authors.initials: PP
authors.lastname: So
authors.forename: Ross A
authors.initials: RA
authors.lastname: Davies
authors.forename: George
authors.initials: G
authors.lastname: Chandy
authors.forename: Duncan
authors.initials: D
authors.lastname: Stewart
authors.forename: Rob S B
authors.initials: RS
authors.lastname: Beanlands
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.forename: Carolyn
authors.initials: C
authors.lastname: Pugliese
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mielniczuk
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control*; D016278:Ventricular Function, Right / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists