Assessment of the prevalence of hypotension in precapillary pulmonary hypertension patients with preserved right ventricle function.

Objectives: Lower SBP is associated with worse prognosis in precapillary pulmonary hypertension patients. This study aimed to assess the prevalence of hypotension in precapillary pulmonary hypertension patients with preserved right ventricle function receiving pulmonary arterial hypertension (PAH)-specific medication with 24-h ambulatory blood pressure monitoring (ABPM) and to compare the burden of hypotension between patients receiving PAH-specific monotherapy and dual combination therapy (DCT).

Methods: This cross-sectional study included 44 precapillary pulmonary hypertension patients who underwent clinical assessment, echocardiography, and 24-h ABPM. Patients were grouped according to the type of treatment regimen: monotherapy or DCT. Hypotension was defined as the occurrence of at least one valid measurement of SBP < 100 mmHg.

Results: Mean 24-h, daytime, and nighttime SBP were significantly lower in patients receiving DCT compared to patients receiving monotherapy (P < 0.05 for all). Episodes with SBP < 100 mmHg during the 24-h, daytime, and nighttime periods were significantly more common in the patients receiving DCT (21.26 ± 9.33 vs 12.26 ± 3.61, 15.58 ± 8.17 vs 8.57 ± 3.60, 5.68 ± 2.63 vs 3.70 ± 2.27, respectively, P < 0.05 for all).

Conclusion: Patients on DCT who had relatively advanced pulmonary vascular disease have a higher burden of hypotension. We propose that estimation of the mortality risk relying on a single office blood pressure measurement, as is the case with contemporary risk scores, may give rise to inaccurate results and the incorporation of the assessment of hypotension burden with 24-h ABPM into the risk assessment tools might improve risk stratification.