Abstract
Experimental studies have suggested potential benefit of beta-blocker therapy in pulmonary arterial hypertension (PAH). Here, we describe the effects of beta-blocker therapy on load-independent measures of RV function.
18 patients with optimally treated, stable iPAH (9/9 NYHA II/III ) were included in a double blind, placebo controlled cross-over trial assessing the safety and efficacy of bisoprolol. (NCT01246037)
An average dose of 4.4±3.2 mg (0-10mg) bisoprolol and 2.7±1.4 tablets placebo was achieved. 5 serious adverse events were reported. One was associated with bisoprolol usage: fluid retention wherefore treatment with iv diuretics was needed. 2/18 patients didn't tolerate bisoprolol.
The primary endpoint of the study is right ventricular ejection fraction (RVEF). The two patients whit Raynaud's syndrome at inclusion, were diagnosed with limited scleroderma (LS) during the study. They showed a severe drop in RVEF of 16% and 21% after treatment. This was reason to also perform a subgroup analysis(table 1).
Conclusions
-In i-PAH beta-blocker therapy is safe and is tolerated.
-There were no significant changes in systolic or diastolic function.
-The subgroup analysis of the patients with LS showed a significant deterioration of RVEF, exercise capacity and RV-arterial uncoupling.
-The subgroup analysis of the patients without LS showed a significant improvement of RVEF and Ees/Ea.
- © 2014 ERS