title: β-blocker therapy is not associated with adverse outcomes in patients with pulmonary arterial hypertension: a propensity score analysis.
abstract: BACKGROUND
  The safety of β-blockers in patients with isolated right ventricular failure because of pulmonary arterial hypertension (PAH) is unclear.
  
  
  RESULTS
  We studied 564 PAH patients (total cohort) referred to our center from 1982 to 2013. Propensity score-matching was used to match pairs of PAH patients with and without β-blocker use (matched cohort). We compared all-cause mortality between the groups in the total cohort and the matched cohort using bootstrap validation, Kaplan-Meier, and Cox proportional hazard analyses. Seventy-one of the 564 patients in the total cohort were on β-blockers. They were older, had higher prevalence of comorbidities, and were more often on diuretics, digoxin, and angiotensin converting enzyme inhibitors. The severity of PAH and right ventricular failure was similar between those with and without β-blocker use. After propensity matching, 63 patients with β-blocker use were compared with 51 patients without β-blocker use. During a median follow-up time of 4.8 years, there were 339 (60%) deaths in the total cohort and 70 deaths (61%) in the matched cohort. There was no difference in absolute mortality between those with and without β-blockers (P=0.71). β-Blocker use was not associated with increased all-cause mortality in the total cohort after adjusting for propensity score (adjusted hazard ratio, 1.0; 95% confidence interval, 0.7-1.5) and in the matched cohort (hazard ratio, 1.2; 95% confidence interval, 0.8-2.0).
  
  
  CONCLUSIONS
  There was no statistically significant difference in long-term mortality between propensity score-matched pairs of PAH patients with and without β-blocker use. These findings need further validation in prospective clinical trials.
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (T.T., S.S.R., S.D.); and Section of Cardiology, Department of Medicine, University of Chicago, IL (C.G.-K., M.G.-M.). tthenapp@umn.edu.
authors.forename: Thenappan
authors.initials: T
authors.lastname: Thenappan
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (T.T., S.S.R., S.D.); and Section of Cardiology, Department of Medicine, University of Chicago, IL (C.G.-K., M.G.-M.).
authors.forename: Samit S
authors.initials: SS
authors.lastname: Roy
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (T.T., S.S.R., S.D.); and Section of Cardiology, Department of Medicine, University of Chicago, IL (C.G.-K., M.G.-M.).
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (T.T., S.S.R., S.D.); and Section of Cardiology, Department of Medicine, University of Chicago, IL (C.G.-K., M.G.-M.).
authors.forename: Cherylanne
authors.initials: C
authors.lastname: Glassner-Kolmin
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (T.T., S.S.R., S.D.); and Section of Cardiology, Department of Medicine, University of Chicago, IL (C.G.-K., M.G.-M.).
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy; D018497:Ventricular Dysfunction, Right / Q000150:complications
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: adrenergic blockers; heart failure; pulmonary hypertension; right ventricle