Deleterious effects of β-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension

Background & Aims: It has been suggested that beta-blockers might be harmful in pulmonary arterial hypertension. However, no study has evaluated the effect of beta-blockers in these patients. The aim of this study was to investigate the effect of beta-blockers on exercise capacity and pulmonary hemodynamics in patients with portopulmonary hypertension receiving beta-blockers for the prophylaxis of variceal bleeding. Methods: Ten consecutive patients with moderate to severe portopulmonary hypertension (mean pulmonary artery pressure of 52 [10] mm Hg) underwent a 6-minute walk test and a right heart catheterization at baseline and 2 (1) months after beta-blocker withdrawal. Results: Following beta-blocker withdrawal, 9 of :10 patients increased their 6-minute walked distance with a mean increase in the whole group of 79 (78) meters (P =.01). Cardiac output increased by 28% (P <.01) with no change in mean pulmonary artery pressure, resulting in a 19% decrease in pulmonary vascular resistance (P <.01). Increases in cardiac output were related to a 25% increase in heart rate (P <.01), whereas stroke volume was unchanged (P =.65). The improvements in exercise tolerance were associated with increases in chronotropic response (maximal heart rate minus resting heart rate) from 18 (9) to 34 (12) beats/min (P <.01) during the 6-minute walk test. Conclusions: In patients with moderate to severe portopulmonary hypertension, beta-blockers are associated with significant worsening in exercise capacity and pulmonary hemodynamics. These deleterious effects support the contraindication of beta-blockers in patients with portopulmonary hypertension.