Pulmonary hypertension linked to poor outcomes in COPD

Chronic obstructive pulmonary disorder (COPD) patients with pulmonary hypertension (PH) appear to have greater functional impairment and poorer outcomes relative to those with idiopathic pulmonary arterial hypertension (IPAH), a study has found.

The study used data from Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and included patients with moderate PH in COPD (n=68), those with severe PH in COPD (n=307), and those with IPAH (n=489).

Compared with IPAH patients, those with PH in COPD were older, more likely to be male, and treated mainly with phosphodiesterase-5 inhibitors.

Haemodynamic impairment was similar across the three groups, but patients with PH in COPD had a poorer performance on 6-min walking distance (6MWD) and showed a more advanced World Health Organization functional class (WHO FC).

Accordingly, transplant-free survival rates in the IPAH group were higher than in the PH in COPD group at 1 year (94 percent vs 86 percent), 3 years (75 percent vs 55 percent), and 5 years (55 percent vs 38 percent; p=0.004).

Among patients with severe PH in COPD, male sex, low 6MWD, and high pulmonary vascular resistance were associated with poor outcomes. On the other hand, improvements in 6MWD by ≥30 m or in WHO FC after initiation of medical therapy predicted better outcomes.

The findings suggest the possibility that some patients with severe PH in COPD may benefit from PH treatment. More studies are needed to explore this possibility.