Last week, during the annual meeting of the American Thoracic Society 2014, Jasmijn van Campen, MD, a staff pulmonologist at VU University Medical Center in Amsterdam gave an oral presentation on her recent work on treating idiopathic pulmonary arterial hypertension with beta blockers.
“Despite the contraindications, beta blockers are prescribed for patients with PAH,” she said, according to an article from MedPageToday. “The main indication for use of beta blockers in PAH patients in several studies was due to heart palpitations.” The session co-moderator, R. Graham Barr, MD associate professor of medicine at Columbia University in New York City, said “This is an interesting first step and subsequent studies will have to be done to show if there is any potential benefit in PAH. It is an interesting hypothesis.”
The research, which was conducted as a double-blind crossover trial, tested the use of beta blocker Bisoprolol (up to a maximum of 10 mg) as a treatment for PAH in a total of 18 patients (17 female), with two groups of 9 participants. The patients had an average age of approximately 48. Of the participants, 4 patients were already prescribed a PAH drug, 11 were on two drugs, and 3 patients were on triple therapy – in addition to receiving the beta blocker.
As was established in the study protocol, all patients were evaluated every 2 weeks, and filled out a quality-of-life questionnaire every month. After a period of 6 months, the patients had a 2-week period while their medication was tapered to zero before the crossover phase was initiated.
Clinically, the study observed an improvement of 4% in right ventricular ejection and an important reduction of heart rate by 10 beats per minute. However, one of the most important outcomes assessed by the Minnesota quality of life questionnaire revealed a significant quality of life improvement in PAH patients.
With a daily dose of 4.4 mg, PAH patients reported no cases of syncope during the entire duration of the 1-year study. The only adverse events were related to fluid retention, and four medical events not related to the study medication. 16 of the 18 patients finished the study, with two dropping out due to Bisoprolol intolerance.
These results are early, of course, and while the data have been presented by the researchers, which can be found at Van Campen J et al, “Beta-blocker therapy in patients with idiopathic pulmonary arterial hypertension: A randomized controlled trial” ATS 2014; Abstract A6569, thorough peer review and additional studies will need to be conducted in order to determine additional safety, and efficacy for the use of beta blockers in treating IPAH. However, these preliminary results could give rise to a new focus for reachers who continue to search for viable treatment options.
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