Key result
Neurohormonal inhibitors linked to ~31-point lower mortality in idiopathic pulmonary arterial hypertension.
Why the study?
Chronic hyperactivity of the neurohormonal axis is detrimental in PAH, but the prognostic effect of neurohormonal blockade in patients with idiopathic PAH and risk factors for left heart disease needed evaluation.
Observational (n=57)
No
Answers are grounded in this paper and cite their sources.
Neurohormonal inhibitor use may link to better survival in idiopathic PAH; hypothesis-generating and requires prospective RCTs before any practice change.
BACKGROUND: Despite major advances in pharmacologic treatment, patients with pulmonary arterial hypertension (PAH) still have a considerably reduced life expectancy. In this context, chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH, thus providing novel insights on the role of neurohormonal blockade as a potential therapeutic target. AIM: To evaluate the application and prognostic effect of neurohormonal inhibitors (NEUi) in a single-center sample of patients with idiopathic PAH and risk factors for left heart disease. METHODS: We analyzed data retrospectively collected from our register of right heart catheterizations performed consecutively from January 1, 2005 to October 31, 2018. Patients on beta-blocker, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker or mineralocorticoid receptor antagonist at the time of right heart catheterization were classified as NEUi users and compared to NEUi non-recipients. CONCLUSION: The above data highlighted a subgroup of patients with PAH and comorbidities for left heart disease in which NEUi use has shown to be associated with improved survival. Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.
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Scagliola et al. (2022) conducted an observational in Idiopathic pulmonary arterial hypertension (n=57). Neurohormonal inhibitors vs. Neurohormonal inhibitor non-recipients was evaluated on Death from any cause (p=0.020). Among patients with idiopathic pulmonary arterial hypertension, use of neurohormonal inhibitors was associated with a significantly lower mortality rate compared to non-use (25.9% vs 56.7%, P=0.020).
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