Dados do Trabalho

Título

Comparing the effects of long-term calcium channel blocker therapy versus targeted therapy in patients with pulmonary hypertension and a positive vasodilator-response test: a systematic review and meta-analysis

Resumo

Introduction
Specific therapies for pulmonary hypertension (PH) can be classified in two different groups: Calcium Channel Blockers (CCBs) and targeted therapy (TT) for Pulmonary Arterial Hypertension (PAH). The assessment of eligible patients for the previously mentioned treatments can be made through the Vasodilator-Response Test (VdT). However, the administration of targeted therapy in VdT-positive patients that exhibit no sustained response to long-term treatment with CCBs remains controversial, prompting questions about its inclusion in these patients’ treatment strategies.

Objective
A meta-analysis was conducted aiming to evaluate and compare the effects of long-term CCB therapy versus targeted therapy in patients with PH and a positive VdT.

Methods
A search was conducted in the following electronic databases: PubMed, Embase, and Cochrane Library. We selected both, randomized and non-randomized studies. The elected primary outcomes of interest were: Mean Pulmonary Artery Pressure (mPAP) and 6-minute walk distance (6MWD). Additionally, we assessed secondary outcomes: Cardiac Index (CI) and Mean Pulmonary Vascular Resistance (mPVR). Statistical analysis was carried out using RevMan 5.4.1, and heterogeneity was assessed using I² statistics.

Results
A total of 3 non-randomized studies were selected, comprising a total of 236 patients, with an average follow-up duration of 3.8 (0.99) years. The mean values observed for individual outcomes in patients with positive VdT, treated with long-term CCBs versus TT, were the following: mPAP (SMD 0.73; 95% CI [0.01, 1.45]; p = 0.05; I²=56%) and 6MWD (SMD -0.48; 95% CI [-1.39, 0.44]; p = 0.31 I²=70%). Additionally, we obtained values for CI (SMD -0.03; 95% CI [0.37, 0.31]; p = 0.85; I²=0%) and mPVR (SMD 0.38; 95% CI [-0.63, 1.38]; p = 0.46; I²=74%).

Conclusion
The study findings suggest that there are no significant differences in the observed improvements of hemodynamic parameters, CI, and 6MWD when comparing long-term CCB therapy to TT for patients with PH and a positive VdT. These results align with the majority of guidelines followed in the current clinical practice, reinforcing their level of evidence.

Palavras Chave

Calcium channel blocker; Pulmonary hypertension; Meta-analysis

Arquivos