The Long-Term Response to Treatment with Calcium Channel Blockers in Patients with Idiopathic Pulmonary Arterial
Azam Kiani1, Razieh Omidvar1, Nasim Naderi1
1Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
Long-term calcium channel blocker (CCB) treatment improved outcomes for 60% of acute responders with idiopathic pulmonary arterial hypertension (IPAH). However, only 18.5% of all IPAH patients showed long-term benefits from CCBs.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Idiopathic pulmonary arterial hypertension (IPAH) is a severe condition with limited long-term treatment outcome data.
- Calcium channel blockers (CCBs) are sometimes used, but their long-term efficacy in IPAH is not well-established.
Purpose of the Study:
- To evaluate the long-term effectiveness of calcium channel blocker (CCB) therapy in patients with idiopathic pulmonary arterial hypertension (IPAH).
- To identify predictors of long-term response to CCB treatment in IPAH patients.
Main Methods:
- Retrospective cohort study of 81 IPAH patients.
- Vasoreactivity testing with adenosine was performed.
- 25 patients with a positive vasoreactivity test were analyzed for long-term CCB response.
Main Results:
- 15 out of 25 patients (60%) were long-term CCB responders.
- Responders showed significant improvements in 6-minute walk test, mixed venous oxygen saturation, and cardiac index after 1 year.
- Responders had better baseline New York Heart Association (NYHA) functional class and less severe hemodynamic parameters.
Conclusions:
- Long-term CCB therapy is effective in a subset of IPAH patients who demonstrate acute vasoreactivity.
- Positive vasoreactivity and favorable baseline characteristics predict better long-term outcomes with CCBs in IPAH.
Background:
Long-term outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH) treated with calcium channel blockers (CCBs) are not well documented. Therefore, this study aimed to determine the long-term response to treatment with CCBs in patients with IPAH.
Methods:
This retrospective cohort study was performed on 81 patients with IPAH admitted to our center. Vasoreactivity testing with adenosine was performed in all patients. Twenty-five patients showed a positive response to vasoreactivity testing and were included in the analysis.
Results:
Of 24 patients, 20 (83.3%) were female, and the mean age of the patients was 45.90±10.42 years. Fifteen patients improved after 1 year on CCB therapy (the long-term CCB responders group), and 9 showed no improvement (the CCB failure group). The CCB responders group had a greater proportion of patients in New York Heart Association (NYHA) functional class I or II (93.3%), a longer distance walked, and less severe hemodynamic parameters. At the 1-year evaluation, the long-term CCB responders had more improvements in the mean 6-minute walk test result (437.43±125.32 vs 268.17±130.06; P=0.040), the mixed venous oxygen saturation level (71.84±9.87 vs 59.03±9.95; P=0.041), and the cardiac index (4.76±1.12 vs 3.15±0.90; P=0.012). Additionally, mPAP was lower in the long-term CCB responders group (47.35±12.70 vs 67.23±14.08; P=0.034). Finally, all the CCB responders were in NYHA functional class I or II (P=0.001).
Conclusion:
Our study illustrated that long-term treatment with oral CCBs was effective in 60% of acute responders and 18.5% of the entire study population.
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