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).

Autor:	Waligóra M; 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., Kurzyna M; Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Centre, Otwock, Poland., Mularek-Kubzdela T; Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland., Skoczylas I; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Katowice, Poland., Chrzanowski Ł; Cardiology Department, Medical University of Lodz, Lodz, Poland., Błaszczak P; Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, Poland., Jaguszewski M; 1st Department of Cardiology, Gdansk, Poland., Kuśmierczyk B; Department of Congenital Heart Disease, Institute of Cardiology, Warsaw, Poland., Ptaszyńska K; Department of Cardiology, Medical University of Bialystok, Bialystok, Poland., Grześk G; Department of Cardiology and Clinical Pharmacology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland., Mizia-Stec K; First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland., Malinowska E; Pulmonary Department, University of Warmia and Mazury, Olsztyn, Poland., Peregud-Pogorzelska M; Department of Cardiology, Pomeranian Medical University, Szczecin, Szczecin, Poland., Lewicka E; Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland., Tomaszewski M; Department of Cardiology, Medical University of Lublin, Lublin, Poland., Jacheć W; 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University in Katowice, Zabrze, Poland., Florczyk M; Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Centre, Otwock, Poland., Mroczek E; Clinic of Heart Diseases, Institute of Heart Diseases, University Clinical Hospital, Wrocław, Poland., Gąsior Z; Department of Cardiology, School of Health Sciences, Medical University of Cardiology in Katowice, Katowice, Poland., Pawlak A; Department of Invasive Cardiology, Polish Academy of Sciences, Mossakowski Medical Research Centre, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland., Betkier-Lipińska K; Department of Cardiology and Internal Medicine, Military Institute of Medicine-National Research Institute, Warsaw, Poland., Pruszczyk P; Department of Internal Medicine and Cardiology, Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warszawa, Poland., Widejko K; Department of Cardiology, Copper Health Center, Lubin, Poland, (y)Department of Cardiology, Provincial Specialist Hospital, Szczecin, Poland., Zabłocka W; Department of Cardiology, Copper Health Center, Lubin, Poland, (y)Department of Cardiology, Provincial Specialist Hospital, Szczecin, Poland., Kopeć G; Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland; Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Krakow, Poland. Electronic address: grzegorzkrakow1@gmail.com.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2024 Nov 09. Date of Electronic Publication: 2024 Nov 09.
DOI:	10.1016/j.chest.2024.10.051
Abstrakt:	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 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: 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. Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. W. has served on a scientific advisory board for Merck & Co (fees paid to self); served as a speaker for Janssen Global Services, LLC, and Merck & Co, Inc, AOP Orphan Pharmaceuticals, and Merck & Co (fees paid to self); and received travel fees from AOP Orphan Pharmaceuticals. E. L. has participated in advisory board meetings for Johnson & Johnson and MSD; and has received payment for lectures from Bayer, Johnson & Johnson, and MSD. G. K. has served as a consultant for Acceleron Pharma, Inc, and Janssen Global Services, LLC; has served on a scientific advisory board (fees paid to self); served as Principal Investigator in a clinical study for Acceleron Pharma, Inc, Bayer, and Janssen Global Services, LLC (fees paid to self); served as a speaker for Bayer, Janssen Global Services, LLC, and Merck & Co, Inc (fees paid to self); served as investigator for Janssen Global Services, LLC (fees paid to self); and received travel fees from Janssen Global Services, LLC, and Merck & Co, Inc (paid to self). None declared (M. K., T. M.-K., I. S., Ł. C., P. B., M. J., B. K., K. P., G. G., K. M.-S., E. Malinowska, M. P.-P., M. T., W. J., M. F., E. Mroczek, Z. G., A. P., K. B.-L., P. P., K. W., W. Z.). (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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