Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

The utility and safety of beta-blockers in pulmonary hypertension is controversial. Anecdotal reports suggest that beta-blockers may be harmful in these patients. The aim of our study was to evaluate outcomes of beta-blocker use in pulmonary hypertension. We reviewed patients from our pulmonary hypertension registry between 2000 and 2011. Patients who continued to use beta-blockers were compared to those who never used beta-blockers for all-cause mortality, time to clinical worsening events, defined as death, lung transplantation and hospitalisation due to pulmonary hypertension. We also evaluated the effect of beta-blockers on 6-min walking distance and New York Heart Association (NYHA) functional class. 133 patients used beta-blockers and 375 patients never used beta-blockers. Mean +/- SD age was 57 +/- 16 years and the median follow-up period was 78 months. Propensity-matched analysis showed that the adjusted odds ratio (95% CI) for mortality with beta-blocker use was 1.13 (0.69-1.82) and for clinical worsening events was 0.96 (0.55-1.68). No significant difference was noted in probability of survival and time to clinical worsening events. Patients on beta-blockers walked a shorter distance on follow-up 6 min walk test; follow-up NYHA class was similar between groups. Pulmonary hypertension patients receiving beta-blockers had a similar survival and time to clinical worsening events compared to patients not receiving them. Functional outcomes were similar, although beta-blocker use was associated with a tendency towards shorter walking distance.