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Pulmonary Vascular Disease |

Outcomes of Beta Blocker Use in Pulmonary Arterial Hypertension

Debabrata Bandyopadhyay, MD; Omar Minai, MD; Jeffery Hammel, MS; Raed Dweik, MD
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Cleveland Clinic, Cleveland, OH


Chest. 2013;144(4_MeetingAbstracts):877A. doi:10.1378/chest.1704010
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Abstract

SESSION TITLE: Pulmonary Hypertension

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM

PURPOSE: The utility and safety of beta blocker use in pulmonary arterial hypertension (PAH) is controversial. Beta blockers are used in various conditions associated with PAH such as ventricular dysfunction and cardiac arrhythmias. The aim of this study is to evaluate the association between beta blocker use and outcomes in PAH patients.

METHODS: We reviewed PAH patients in our pulmonary hypertension registry between 1998 and 2012. PAH was defined as mPAP ≥ 25 mm of Hg; PCWP ≤ 15 mm of Hg and PVR > 3 Wood. We compared two groups of PAH patients: those who have been on beta blocker (BB) at least more than a month compared to those who never used beta blockers. We analyzed the time to the composite end point of all cause of mortality, lung transplant, or PAH related hospitalization. We also evaluated the effect on six-minute walk test (6-MWT) distance and NYHA functional class.

RESULTS: A total of 246 patients (63% females) with PAH used beta blockers (BB group) and 429 patients (72% females) were never on beta blockers (No-BB group). Mean age was 57 ± 16 years. The largest group of patients had IPAH (38%). Median follow up period was 64 months. Median duration of BB use was 36 months. Metoprolol was the most common BB used; most common indication was cardiac arrhythmia. There was no significant difference among the groups in terms of LVEF, pulmonary artery pressures, PVR, cardio-pulmonary co-morbidities, or oxygen therapy. Over the duration of follow up only 55% percent of patients in the BB group reached the composite end point compared to 60% in the No-BB group (P=0.16). The BB group had significantly lower overall mortality (41% vs 50% p=0.017). However, in a multivariate model (controlling for NYHA class, age, COPD, OSA, prostacyclins use, and 6-MWT distance), BB use had no effect on overall survival (HR 0.67; p=0.10), transplant-free survival and hospitalization (HR 1.15, p=0.45). There was no difference in the change in NYHA functional class over time irrespective of BB use.

CONCLUSIONS: Long term use of beta blockers in pulmonary hypertension shows no evidence of a detrimental effect on overall survival after adjustment for relevant factors. Randomized controlled studies are needed to determine if beta-blocker use can produce a survival benefit.

CLINICAL IMPLICATIONS: BB use is safe in PAH patients.

DISCLOSURE: The following authors have nothing to disclose: Debabrata Bandyopadhyay, Omar Minai, Jeffery Hammel, Raed Dweik

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