• Marcin Waligóra, Marcin Kurzyna, Tatiana Mularek-Kubzdela, Ilona Skoczylas, Łukasz Chrzanowski, Piotr Błaszczak, Miłosz Jaguszewski, Beata Kuśmierczyk, Katarzyna Ptaszyńska, Grzegorz Grześk, Katarzyna Mizia-Stec, Ewa Malinowska, Małgorzata Peregud-Pogorzelska, Ewa Lewicka, Michał Tomaszewski, Wojciech Jacheć, Michał Florczyk, Ewa Mroczek, Zbigniew Gąsior, Agnieszka Pawlak, Katarzyna Betkier-Lipińska, Piotr Pruszczyk, Katarzyna Widejko, Wiesława Zabłocka, and Grzegorz Kopeć.
• Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Krakow, Poland; Center for Innovative Medical Education, Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
• Chest. 2024 Nov 9.

BackgroundCurrent guidelines do not recommend β-blockers in pulmonary arterial hypertension (PAH) unless indicated by comorbidities. However, the evidence regarding the role of β-blockers in PAH is contradictory.Research QuestionWhat are the effects of β-blockers on clinical outcomes in patients newly diagnosed with PAH, and how do these outcomes differ based on the presence of cardiovascular comorbidities that are standard indications for β-blocker use?Study Design And MethodsWe analyzed data from 806 patients newly diagnosed with PAH enrolled prospectively in the Database of Pulmonary Hypertension in the Polish Population (BNP-PL). The end points were all-cause mortality and a composite of hospitalization due to right heart failure, syncope, or death. Indications for β-blocker use included hypertension, significant arrhythmia, and coronary artery disease. Propensity score matching was used to form a control group based on age, PAH mortality risk variables, and initially introduced PAH-specific therapy.ResultsOf the 806 patients, 469 (58.2%) received β-blockers at the time of PAH diagnosis. In propensity score matching, β-blocker treatment showed a higher incidence of the composite end point (hazard ratio, 1.44; 95% CI, 1.04-1.99; P = .03) and had a neutral impact on mortality (hazard ratio, 1.22; 95% CI, 0.87-1.72; P = .25). When stratified according to the presence of comorbidities, β-blockers showed adverse effects on the composite end point in patients without comorbidities and a neutral effect in patients with at least one comorbidity.Interpretationβ-blockers pose significant risks in patients with PAH, especially in patients without coexisting systemic hypertension, coronary artery disease, or arrhythmia.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT03959748; URL: www.Clinicaltrialsgov.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

5 keywords...

hide…