Beta-blockers associated with worse outcomes in new PAH
Death or hospitalization due to right-heart failure or syncope was more likely in patients who received beta-blockers after a new pulmonary arterial hypertension (PAH) diagnosis, especially if they had no cardiovascular comorbidities, a retrospective Polish study found.
Patients with a new diagnosis of pulmonary arterial hypertension (PAH) may do worse if prescribed beta-blockers, a recent study found.
Researchers in Poland analyzed data from patients newly diagnosed with PAH to determine how beta-blockers affected clinical outcomes in those with and without cardiovascular comorbid conditions. The study end points were all-cause mortality and a composite of death or hospitalization due to right-heart failure or syncope. The researchers used propensity score matching to form a control group based on age, variables indicating PAH mortality risk, and initial PAH-specific therapy. The results were published Nov. 8 by CHEST.
Eight hundred six patients were included in the study (mean age, 66 years; 67.2% women). Of these, 469 (58.2%) received beta-blockers at PAH diagnosis and 337 (41.8%) did not. Types of beta-blockers included selective beta1-blockers (69.1%), selective beta1-blockers acting as beta3-agonists (22.6%), nonselective beta-blockers (6.1%), and nonselective beta-blockers combined with class III antiarrhythmic agents (2.1%). Overall, 7.5% of patients who received beta-blockers had three comorbid conditions, 30.7% had two, and 46.5% had one, while 15.4% appeared to have no relevant indication. Hypertension, significant arrhythmia, and coronary artery disease (CAD) were among the cardiovascular conditions considered indications for beta-blocker use.
In the propensity-matched cohort, patients who received beta-blockers had a higher incidence of the composite end point (hazard ratio [HR], 1.44 [95% CI, 1.04 to 1.99]; P=0.03) but the effect on all-cause mortality appeared to be neutral (HR, 1.22 [95% CI, 0.87 to 1.72]; P=0.25). When outcomes in the secondary propensity-matched cohort were stratified by beta-blocker selectivity, nonselective agents were associated with a higher risk of the composite end point (HR, 1.69 [95% CI, 1.03 to 2.79]; P=0.038) but not all-cause mortality (HR, 1.27 [95% CI, 0.72 to 2.22]; P=0.41) versus selective agents.
Among other limitations, the study was observational and did not account for changes in beta-blocker type or dose, the researchers wrote. “Our study does not support the routine administration of β-blockers in patients with PAH,” they wrote. “Instead, a cautious approach is warranted, and their use should only be considered in patients with comorbidities that clearly justify their prescription such as hypertension, CAD, or significant arrhythmia.” They also noted that nonselective beta-blockers were linked to worse survival than beta1-selective agents.