Reuters Health Information (2006-02-20): Beta-blockers harmful in patients with portopulmonary hypertension
Beta-blockers harmful in patients with portopulmonary hypertension
Last Updated: 2006-02-20 15:30:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - The findings of a small study confirm that beta-blockers should be avoided in patients with pulmonary arterial hypertension related to portal hypertension. The use of beta-blockers in these patients worsens exercise capacity and pulmonary hemodynamics.
Patients with portopulmonary hypertension are often given beta-blockers to prevent variceal bleeding. While it has been hypothesized that due to their negative chronotropic and vasoconstrictive effect these agents might be harmful in this patient group, until now, no study had looked at their effects on pulmonary hemodynamics and exercise capacity.
As reported in the January issue of Gastroenterology, Dr. Steeve Provencher, from Hopital Antoine Beclere in Clamart, France, and colleagues assessed the effects of beta-blockers in 10 patients with portopulmonary hypertension who were given the drugs to prevent variceal bleeding. Eight patients were using propranolol and two were using atenolol.
A 6-minute walking test and right heart catheterization were performed at baseline and several weeks after beta-blocker discontinuation.
Nine of 10 patients experienced an improvement in the walking test following beta-blocker discontinuation (p = 0.01). This improvement was associated with an increase in the chronotropic response during the test.
In addition, cardiac output increased by 28% and pulmonary vascular resistance fell by 19% when these drugs were stopped (p < 0.01 for both). Stroke volume did not change with beta-blocker discontinuation, but the rise in cardiac output was associated with 25% increase in heart rate.
"Our findings indicate that, because of their major negative influence on exercise capacity and pulmonary hemodynamics, beta-blockers are not recommended in patients with moderate to severe portopulmonary hypertension and suggest that other forms of prophylaxis such as variceal band ligation are clearly recommended for patients at risk of bleeding," the authors conclude.