Usefulness of beta-blocker therapy and outcomes in patients with pulmonary arterial hypertension

Am J Cardiol. 2012 May 15;109(10):1504-9. doi: 10.1016/j.amjcard.2012.01.368. Epub 2012 Mar 3.


Pulmonary arterial hypertension (PAH) is a disorder in which pulmonary arterial remodeling and vasoconstriction progressively lead to right heart failure (HF), exercise intolerance, and high mortality. Beta-blockers have been shown to decrease mortality in left-sided HF, but their efficacy in isolated right HF associated with PAH is uncertain. Patients with PAH may have cardiac co-morbidities for which β-blocker therapy is indicated, and the relative risk benefit of this therapy remains to be proved. This is a prospective cohort study of 94 consecutive patients with PAH divided into 2 groups with and without β-blocker use at baseline. Rate of all-cause mortality, PAH-related hospitalization, change in 6-minute walk test, right ventricular structure and function measured by echocardiography, and hemodynamics measured by right heart catheterization were determined between subjects with and without β-blocker use. Beta-blocker use was common (28%) in this cohort. After a median follow-up of 20 months, changes in pulmonary hemodynamics and right ventricular size and function were similar between groups. There were no statistically significant differences in adverse events including PAH-related hospitalization or all-cause mortality (p = 0.19), presence of right HF by last visit (p = 0.75), or change in last 6-minute walk distance (p = 0.92). In conclusion, β-blocker use is not uncommon in a select group of patients with PAH and cardiac co-morbidities and did not appear to exert detrimental effects in clinical, functional, and hemodynamic outcomes. Further randomized data are needed to evaluate the potential benefits and risks of β-blocker use in patients with PAH.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Familial Primary Pulmonary Hypertension
  • Female
  • Follow-Up Studies
  • Heart Failure / etiology
  • Heart Failure / physiopathology
  • Heart Failure / prevention & control*
  • Humans
  • Hypertension, Pulmonary / complications
  • Hypertension, Pulmonary / drug therapy*
  • Hypertension, Pulmonary / mortality
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Prospective Studies
  • Pulmonary Wedge Pressure / drug effects
  • Risk Factors
  • Survival Rate / trends
  • Treatment Outcome
  • Vascular Resistance / drug effects*
  • Ventricular Dysfunction, Right / complications
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Dysfunction, Right / prevention & control*
  • Ventricular Function, Right / drug effects


  • Adrenergic beta-Antagonists