Written by Peter Liu
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For patients with pulmonary arterial hypertension (PAH), beta-blocker use is associated with worse outcomes in the absence of comorbid indications for beta-blocker therapy.
Synopsis
This study evaluated the impact of β-blockers on outcomes in newly diagnosed pulmonary arterial hypertension (PAH) patients, focusing on the role of cardiovascular comorbidities. Using a prospective cohort of 806 patients from the BNP-PL registry and propensity score matching, researchers analyzed all-cause mortality and a composite endpoint (hospitalization, syncope, or death). β-blocker use increased the composite endpoint risk (HR 1.44, 95%CI 1.04–1.99; p = 0.03) but did not affect mortality (HR 1.22; p = 0.25). Adverse effects were prominent in patients without comorbidities but neutral in those with hypertension or arrhythmias. Limitations included the observational design and unstandardized β-blocker use. Routine β-blocker use in PAH is discouraged without clear comorbid indications. (AI-assisted)
Take care with beta-blockers in PAH
This high-quality nonrandomized, observational study provides compelling evidence for three hypotheses:
- For patients with PAH and no other indication, beta-blocker use leads to worse outcomes – especially heart failure admissions and syncope.
- Patients with PAH taking non-cardioselective beta-blockers fare worse than those taking cardioselective beta-blockers.
- If other compelling indications for beta-blockade are present, beta-blockers are not strictly contraindicated for patients with PAH.
These findings are consistent with European Society of Cardiology 2017 guidelines: “The use of angiotensin-converting enzyme inhibitors, angiotensin-2 receptor antagonists, beta-blockers and ivabradine is not recommended in patients with PAH unless required by co-morbidities (i.e. high blood pressure, coronary artery disease or left heart failure)“. In addition to these principles, I generally favor temporarily hold beta-blockers during acute decompensations of PAH warranting hospitalization.
Source
Effects of β-Blockers on the Outcomes in Patients With Pulmonary Arterial Hypertension Stratified by the Presence of Comorbid Conditions: A Multicenter Prospective Cohort Study (BNP-PL). Chest. 2024 Nov 9:S0012-3692(24)05471-0. doi: 10.1016/j.chest.2024.10.051. Epub ahead of print. PMID: 39528108
Hmmm