Use of β-Blockers in Pulmonary Hypertension

Abstract

Contrasting with the major attention that left heart failure has received, right heart failure remains understudied both at the preclinical and clinical levels. However, right ventricle failure is a major predictor of outcomes in patients with precapillary pulmonary hypertension because of pulmonary arterial hypertension, and in patients with postcapillary pulmonary hypertension because of left heart disease. In pulmonary hypertension, the status of the right ventricle is one of the most important predictors of both morbidity and mortality. Paradoxically, there are currently no approved therapies targeting the right ventricle in pulmonary hypertension. By analogy with the key role of β-blockers in the management of left heart failure, some authors have proposed to use these agents to support the right ventricle function in pulmonary hypertension. In this review, we summarize the current knowledge on the use of β-blockers in pulmonary hypertension.

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

“…Effects of neurohormonal modulators (e.g., inhibitors of the renin-angiotensin/aldosterone system) and b-adrenergic receptor antagonists on RV contractile function require further study. In particular, the effect of the latter is of great interest, because currently available studies yielded conflicting results of these drugs on clinical outcomes and RV function (259)(260)(261)(262)(263). RV inotropic agents may improve shortand/or long-term outcomes in acute and/or chronic PH, but their role (and potential for adverse events) is incompletely explored.…”

Characterization of Patients with Pulmonary Arterial Hypertension: Data from the Polish Registry of Pulmonary Hypertension (BNP-PL)

“…Recently, targeting the negative consequences of chronic sympathetic nerve activation with use of beta-blockers, and renal or pulmonary artery denervation has attracted interest. Till now, however, no clear demonstration of a favorable benefit-to-risk ratio of these therapies in PAH patients has been provided and multicenter randomized trials are needed to adapt their use in clinical practice [38].…”

Pulmonary arterial hypertension: the case for a bioelectronic treatment

“…At the cellular level, beta blockers decrease RV myocardial hypertrophy and fibrosis, capillary rarefaction, apoptosis and inflammation (Bogaard et al 2010;de Man et al 2012ade Man et al , 2013Ishikawa et al 2009;Perros et al 2015). With regards to RV function, beta blockers reduce RV hypertrophy, increase RV and LV ejection fraction, decrease myocardial oxygen consumption and RV afterload (Perros et al 2017). However, due to the reduction of heart rate and cardiac output, as well as the negative impact on exercise capacity (Bandyopadhyay et al 2015;Provencher et al 2006;Thenappan et al 2014;van Campen et al 2016), current guidelines do not recommend their use in PH patients except for those with comorbidities such as arrhythmia, high blood pressure, coronary artery disease and left heart failure (Galie et al 2016).…”