BACKGROUND The 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 pulmonary arterial hypertension (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 endpoints were all-cause mortality and a composite of hospitalization due to right heart failure, syncope or death. Indications for β-blocker included hypertension, significant arrhythmia, and coronary artery disease(CAD). Propensity score matching (PSM) was used to form a control group based on age, PAH mortality risk variables and initially introduced PAH specific therapy. RESULTS Out of the 806 patients, 469 (58.2%) received β-blockers at the time of PAH diagnosis. In PSM, β-blocker treatment showed a higher incidence of the composite endpoint (HR:1.44; 95% CI: 1.04-1.99; P = .03) and had neutral impact on mortality (HR, 1.22; 95% CI, 0.87-1.72; P = .25). When stratified by the presence of comorbidities, β-blockers showed adverse effects on composite endpoint 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, CAD and arrhythmia.

中文翻译：

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β阻滞剂对按合并症分层的肺动脉高压患者预后的影响：一项多中心前瞻性队列研究 （BNP-PL）。


背景 目前的指南不建议在肺动脉高压 （PAH） 中使用 β 阻滞剂，除非有合并症指征。然而，关于 β 阻滞剂在 PAH 中的作用的证据是矛盾的。研究问题 β阻滞剂对新诊断的肺动脉高压 （PAH） 患者的临床结局有何影响，这些结局如何根据作为 β阻滞剂使用标准适应症的心血管合并症的存在而有所不同？研究设计和方法 我们分析了前瞻性纳入波兰人群肺动脉高压数据库 （BNP-PL） 的 806 名新诊断为 PAH 患者的数据。终点是全因死亡率和因右心衰竭、晕厥或死亡而住院的复合终点。β阻滞剂的适应证包括高血压、严重心律失常和冠状动脉疾病 （CAD）。倾向评分匹配 （PSM） 用于根据年龄、 PAH 死亡率风险变量形成对照组，并最初引入 PAH 特异性治疗。结果 在 806 例患者中，469 例 （58.2%） 在诊断 PAH 时接受了 β 阻滞剂。在 PSM 中，β阻滞剂治疗显示复合终点的发生率较高 （HR：1.44;95% CI：1.04-1.99;P = .03），对死亡率有中性影响 （HR，1.22;95% CI，0.87-1.72;P = .25）。当按合并症的存在进行分层时，β阻滞剂对无合并症患者的复合终点显示不利影响，而对至少有一种合并症的患者显示中性影响 解释：β阻滞剂对 PAH 患者构成重大风险，尤其是在没有共存全身性高血压、CAD 和心律失常的患者中。