Poorer outcomes in patients with pulmonary hypertension in COPD

Patients with pulmonary hypertension in COPD had worse clinical status and poorer outcomes compared with those with idiopathic pulmonary artery hypertension, according to findings published in Chest.

“The clinical importance of pulmonary hypertension associated with COPD has been documented in several studies that demonstrated the independent prognostic role of pulmonary hypertension in this population,” Carmine Dario Vizza, MD, associate professor of cardiology and director of the Pulmonary Hypertension Unit at the University of Rome La Sapienza, Rome, and colleagues wrote. “It is unclear whether patients with pulmonary hypertension in COPD may benefit from treating the pulmonary vascular disease component.”

Researchers evaluated characteristics and outcomes of patients with moderate (n = 68) or severe (n = 307) pulmonary hypertension in COPD from the COMPERA registry. All received medical therapy for pulmonary hypertension. The researchers compared outcomes with 489 patients with idiopathic PAH.

Patients with pulmonary hypertension in COPD were older (68.4 years vs. 61.7 years), mostly men (59% vs. 37%) and were more likely treated with phosphodiesterase type 5 inhibitors (92% vs. 52%) compared with those with idiopathic PAH.

Patients with pulmonary hypertension in COPD had worse 6-minute walking distance (247 m vs. 326 m) and more advanced WHO functional class (III: 69% vs. 68%; IV: 23% vs. 9%) compared with patients with idiopathic PAH. Patients with pulmonary hypertension in COPD and those with idiopathic PAH had similar hemodynamic impairment.

Rates of transplant-free survival were higher at 1 year (94% vs. 86%), 3 years (75% vs. 55%) and 5 years (55% vs. 38%) among patients with idiopathic PAH compared with patients with pulmonary hypertension in COPD (P = .004).

Male sex (RR = 1.4; 95% CI, 0.95-2.05), low 6-minute walking distance (RR = 0.96; 95% CI, 0.94-0.98) and high pulmonary vascular resistance (RR = 1.05; 95% CI, 0.97-1.14) were identified by the researchers as risk factors for poorer outcomes in patients with pulmonary hypertension in COPD.

Better outcomes were observed in patients with severe pulmonary hypertension in COPD when patients demonstrated an improvement of at least 30 m in 6-minute walking distance or improvements in WHO functional class following medical therapy initiation.

“Our data suggest that pulmonary hypertension-targeted drug therapy in patients with COPD and severe pulmonary hypertension may improve exercise tolerance and WHO functional class in a subgroup of patients and that patients with COPD and pulmonary hypertension who respond to therapy may have a better prognosis than patients who do not show clinical improvement,” the researchers wrote. “These findings need to be explored further in prospective, randomized controlled clinical studies.”