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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ETreatment of idiopathic pulmonary arterial hypertension (PAH) with the \u03b2-blocker bisoprolol resulted in decreased heart rate, increased right ventricular ejection fraction (RVEF), and improved quality of life. This article presents data from the Beta-Blocker Therapy in Idiopathic Pulmonary Arterial Hypertension trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01246037\u0026amp;atom=%2Fspmdc%2F14%2F11%2F21.atom\u0022\u003ENCT01246037\u003C\/a\u003E; Van Campen JSJA et al. \u003Cem\u003EAm J Respir Crit Care\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThromboembolic Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary \u0026amp; Critical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThromboembolic Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPulmonary Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ETreatment of idiopathic pulmonary arterial hypertension (PAH) with the \u03b2-blocker bisoprolol resulted in decreased heart rate, increased right ventricular ejection fraction (RVEF), and improved quality of life (QoL). J.S.J.A. Van Campen, MD, VU Medical Center, Amsterdam, The Netherlands, presented data from the Beta-Blocker Therapy in Idiopathic Pulmonary Arterial Hypertension trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01246037\u0026amp;atom=%2Fspmdc%2F14%2F11%2F21.atom\u0022\u003ENCT01246037\u003C\/a\u003E; Van Campen JSJA et al. \u003Cem\u003EAm J Respir Crit Care\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe sympathetic nervous system is excessively active in PAH; however, blockade by \u03b2-blockers was thought to be contraindicated because of the acute negative inotropic and chronotropic effects. Despite similar thinking, blockade of \u03b2-adrenergic receptors in patients with left heart failure has been shown to reduce left ventricular remodeling and mortality by about 30% [Dickstein K et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008]. In addition, data from recent preclinical animal studies suggest that low-dose \u03b2-blocker therapy may be beneficial in PAH [De Man FS et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2012]. The purpose of this study was to determine if bisoprolol is safe and effective in patients with PAH.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn this double-blind, crossover, Phase 1 and 2 trial, 18 patients with optimally treated, stable idiopathic PAH received an escalating dose of up to 10 mg of bisoprolol or placebo for up to 6 months, then crossed over to the opposite treatment for up to an additional 6 months (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Patients were assessed every 2 weeks by physical examination with blood pressure and heart rate measurements. Every month, patients underwent electrocardiography, 6-minute walking distance (6MWD) tests, and the Minnesota Living With Heart Failure Questionnaire assessing QoL. In addition, at baseline, crossover, and end of the study, patients were evaluated by magnetic resonance imaging (MRI), echocardiography, heart rate variability measurements, cardiopulmonary exercise testing, and positron emission tomography.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/11\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Trial Design of the Beta-Blocker Therapy in Idiopathic PAH Trial\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1855477499\u0022 data-figure-caption=\u0022Trial Design of the Beta-Blocker Therapy in Idiopathic PAH Trial\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/11\/21\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/11\/21\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/11\/21\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14353\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ETrial Design of the Beta-Blocker Therapy in Idiopathic PAH Trial\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EPAH=pulmonary arterial hypertension.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from JSJA Van Campen, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EThe primary end point of the study was RVEF, as measured by cardiac MRI. The secondary end points included assessments of sympathetic overdrive, maladaptive remodeling of the right ventricular wall, perfusion, mechanical efficiency, and exercise capacity.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPatients who received bisoprolol (mean dose, 4.4 \u00b1 3.2 mg) demonstrated an improvement in RVEF by 3%, which was not statistically significant. However, bisoprolol treatment resulted in a significant decrease in heart rate (p=0.0001), with most patients (15 of 18) experiencing reductions of 10 beats\/min. Significant decreases were also seen in cardiac output (p=0.02) and cardiac output, as measured by the 6-minute walk test (p\u0026lt;0.02). There were no significant differences in maximal oxygen consumption or QoL.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EOf 18 patients, 5 experienced serious adverse effects; however, 4 events were determined to not be associated with the study drug. One patient experienced fluid retention at the beginning of bisoprolol treatment that required intravenous diuretics. Two patients did not tolerate bisoprolol, secondary to hypotension, bradycardia, or fatigue. Syncope was not reported during the study.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn conclusion, Prof. van Campen stated that data from this trial indicated that treatment of PAH with a \u03b2-blocker is safe and well tolerated. In addition, \u03b2-blocker treatment can reduce heart rate and improve RVEF and QoL, without significantly affecting exercise capacity.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/11\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp28d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp28d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}