Marcin Waligóra, Marcin Kurzyna, Tatiana Mularek-Kubzdela, Ilona Skoczylas, Łukasz Chrzanowski, Piotr Błaszczak, Miłosz Jaguszewski, Beata Kuśmierczyk, Katarzyna Ptaszyńska, Grzegorz Grześk, Katarzyna Mizia-Stec, Ewa Malinowska, Małgorzata Peregud-Pogorzelska, Ewa Lewicka, Michał Tomaszewski, Wojciech Jacheć, Michał Florczyk, Ewa Mroczek, Zbigniew Gąsior, Agnieszka Pawlak, Katarzyna Betkier-Lipińska, Piotr Pruszczyk, Katarzyna Widejko, Wiesława Zabłocka, Grzegorz Kopeć
{"title":"多中心前瞻性队列研究（BNP-PL）：β-受体阻滞剂对肺动脉高压患者疗效的影响（根据合并症情况进行分层","authors":"Marcin Waligóra, Marcin Kurzyna, Tatiana Mularek-Kubzdela, Ilona Skoczylas, Łukasz Chrzanowski, Piotr Błaszczak, Miłosz Jaguszewski, Beata Kuśmierczyk, Katarzyna Ptaszyńska, Grzegorz Grześk, Katarzyna Mizia-Stec, Ewa Malinowska, Małgorzata Peregud-Pogorzelska, Ewa Lewicka, Michał Tomaszewski, Wojciech Jacheć, Michał Florczyk, Ewa Mroczek, Zbigniew Gąsior, Agnieszka Pawlak, Katarzyna Betkier-Lipińska, Piotr Pruszczyk, Katarzyna Widejko, Wiesława Zabłocka, Grzegorz Kopeć","doi":"10.1016/j.chest.2024.10.051","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Research question: </strong>What are the effects of β-blockers on clinical outcomes in patients newly diagnosed with PAH, and how do these outcomes differ based on the presence of cardiovascular comorbidities that are standard indications for β-blocker use?</p><p><strong>Study design and methods: </strong>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 end points were all-cause mortality and a composite of hospitalization due to right heart failure, syncope, or death. Indications for β-blocker use included hypertension, significant arrhythmia, and coronary artery disease. Propensity score matching was used to form a control group based on age, PAH mortality risk variables, and initially introduced PAH-specific therapy.</p><p><strong>Results: </strong>Of the 806 patients, 469 (58.2%) received β-blockers at the time of PAH diagnosis. In propensity score matching, β-blocker treatment showed a higher incidence of the composite end point (hazard ratio, 1.44; 95% CI, 1.04-1.99; P = .03) and had a neutral impact on mortality (hazard ratio, 1.22; 95% CI, 0.87-1.72; P = .25). When stratified according to the presence of comorbidities, β-blockers showed adverse effects on the composite end point in patients without comorbidities and a neutral effect in patients with at least one comorbidity.</p><p><strong>Interpretation: </strong>β-blockers pose significant risks in patients with PAH, especially in patients without coexisting systemic hypertension, coronary artery disease, or arrhythmia.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT03959748; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5000,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of β-Blockers on the Outcomes in Patients With Pulmonary Arterial Hypertension Stratified by the Presence of Comorbid Conditions: A Multicenter Prospective Cohort Study (BNP-PL).\",\"authors\":\"Marcin Waligóra, Marcin Kurzyna, Tatiana Mularek-Kubzdela, Ilona Skoczylas, Łukasz Chrzanowski, Piotr Błaszczak, Miłosz Jaguszewski, Beata Kuśmierczyk, Katarzyna Ptaszyńska, Grzegorz Grześk, Katarzyna Mizia-Stec, Ewa Malinowska, Małgorzata Peregud-Pogorzelska, Ewa Lewicka, Michał Tomaszewski, Wojciech Jacheć, Michał Florczyk, Ewa Mroczek, Zbigniew Gąsior, Agnieszka Pawlak, Katarzyna Betkier-Lipińska, Piotr Pruszczyk, Katarzyna Widejko, Wiesława Zabłocka, Grzegorz Kopeć\",\"doi\":\"10.1016/j.chest.2024.10.051\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Research question: </strong>What are the effects of β-blockers on clinical outcomes in patients newly diagnosed with PAH, and how do these outcomes differ based on the presence of cardiovascular comorbidities that are standard indications for β-blocker use?</p><p><strong>Study design and methods: </strong>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 end points were all-cause mortality and a composite of hospitalization due to right heart failure, syncope, or death. Indications for β-blocker use included hypertension, significant arrhythmia, and coronary artery disease. Propensity score matching was used to form a control group based on age, PAH mortality risk variables, and initially introduced PAH-specific therapy.</p><p><strong>Results: </strong>Of the 806 patients, 469 (58.2%) received β-blockers at the time of PAH diagnosis. In propensity score matching, β-blocker treatment showed a higher incidence of the composite end point (hazard ratio, 1.44; 95% CI, 1.04-1.99; P = .03) and had a neutral impact on mortality (hazard ratio, 1.22; 95% CI, 0.87-1.72; P = .25). When stratified according to the presence of comorbidities, β-blockers showed adverse effects on the composite end point in patients without comorbidities and a neutral effect in patients with at least one comorbidity.</p><p><strong>Interpretation: </strong>β-blockers pose significant risks in patients with PAH, especially in patients without coexisting systemic hypertension, coronary artery disease, or arrhythmia.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT03959748; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>\",\"PeriodicalId\":9782,\"journal\":{\"name\":\"Chest\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2024-11-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chest\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.chest.2024.10.051\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.10.051","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Effects of β-Blockers on the Outcomes in Patients With Pulmonary Arterial Hypertension Stratified by the Presence of Comorbid Conditions: A Multicenter Prospective Cohort Study (BNP-PL).
Background: 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 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 end points were all-cause mortality and a composite of hospitalization due to right heart failure, syncope, or death. Indications for β-blocker use included hypertension, significant arrhythmia, and coronary artery disease. Propensity score matching was used to form a control group based on age, PAH mortality risk variables, and initially introduced PAH-specific therapy.
Results: Of the 806 patients, 469 (58.2%) received β-blockers at the time of PAH diagnosis. In propensity score matching, β-blocker treatment showed a higher incidence of the composite end point (hazard ratio, 1.44; 95% CI, 1.04-1.99; P = .03) and had a neutral impact on mortality (hazard ratio, 1.22; 95% CI, 0.87-1.72; P = .25). When stratified according to the presence of comorbidities, β-blockers showed adverse effects on the composite end point 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, coronary artery disease, or arrhythmia.
期刊介绍：
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
