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: The Database of Pulmonary Hypertension in the Polish Population (BNP-PL).

BACKGROUND

Current 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 QUESTION: What 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

METHODS

We 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-sided 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.

RESULTS

Of 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.

INTERPRETATION: Our results indicate that β-blockers pose significant risks in patients with PAH, especially in patients without coexisting systemic hypertension, coronary artery disease, or arrhythmia.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03959748; URL: www.

CLINICALTRIALS: gov.