Beta Blockers Have Positive Effect in Pulmonary Arterial Hypertension

A team of Lerner Research Institute researchers has determined that beta blockers, a common heart disease medication, may help treat pulmonary arterial hypertension (PAH), a debilitating lung disease.

Right-sided heart failure is the leading cause of death in PAH patients. Although right ventricular dysfunction (which usually leads to right-sided heart failure) occurs independently of increased blood pressure, all currently approved PAH treatments target the pulmonary vessels rather than address the heart dysfunction that is the more likely cause of death in these patients.

In contrast, targeting left ventricular dysfunction has been the foundation of left-sided heart failure therapy for nearly 40 years. Beta blockers such as carvedilol are the cornerstone therapy in left-sided heart failure.

Researchers led by Serpil Erzurum, MD, practicing pulmonologist and chair of Lerner Research Institute and W. H. Wilson Tang, MD, practicing cardiologist and joint staff in Lerner's Department of Cellular and Molecular Medicine, were interested to know whether carvedilol may also benefit patients with PAH, who currently have few treatment options.

They assessed carvedilol use in a group of 30 patients with PAH in a double-blind, randomized study. The participants received either placebo, low fixed-dose or escalating doses of carvedilol over a six-month period. Results showed that the drug lowered heart rate in correlation with carvedilol dose, improved heart rate recovery from exercise and did not worsen heart failure or lead to airflow deterioration.

Previously, the use of beta blockers in PAH patients had not been widely studied due mostly to anecdotal concerns about decreased lung capacity. But these findings suggest carvedilol is safe to use in PAH patients for six months with evidence of improved outcomes that could prevent right-sided heart failure.

This study provides important and promising new data that upon further study may help many PAH patients who currently have few and largely ineffective treatment options.

Dr. Erzurum holds the Alfred Lerner Memorial Chair in Innovative Biomedical Research and is a member of the medical staff in Lerner Research Institute's Department of Pathobiology and Cleveland Clinic's Respiratory Institute. Dr. Tang is a transplant cardiologist in the Miller Heart and Vascular Institute and directs Cleveland Clinic's Center for Clinical Genomics.

Samar Fahra, MD, associate staff in Cleveland Clinic's Respiratory Institute, is first author on the study. This work was supported by the National Institutes of Health and published in JCI Insight.