{"doi":"10.3390/jcdd10120498","title":"Pulmonary Vasodilator Therapy in Severe Pulmonary Hypertension Due to Chronic Obstructive Pulmonary Disease (Severe PH-COPD): A Systematic Review and Meta-Analysis","abstract":"<jats:p>Background: Chronic obstructive pulmonary disease-associated pulmonary hypertension (PH-COPD) results in a significant impact on symptoms, quality of life, and survival. There is scant and conflicting evidence about the use of pulmonary hypertension (PH) specific therapy in patients with PH-COPD. Study Design and Methods: PubMed, OVID, CINAHL, Cochrane, Embase, and Web of Science were searched using various MESH terms to identify randomized controlled trials (RCTs) or observational studies investigating PH-specific therapies in patients with severe PH-COPD, defined by mean pulmonary artery pressure (mPAP) of more than 35 mm Hg or pulmonary vascular resistance (PVR) of more than 5 woods units on right heart catheterization. The primary outcome was a change in mPAP and PVR. Secondary outcomes were changes in six-minute walk distance (6MWD), changes in the brain-natriuretic peptide (BNP), New York Heart Association (NYHA) functional class, oxygenation, and survival. Results: Thirteen studies satisfied the inclusion criteria, including a total of 328 patients with severe PH-COPD. Out of these, 308 patients received some type of specific therapy for PH. There was a significant reduction in mPAP (mean difference (MD) −3.68, 95% CI [−2.03, −5.32], p &lt; 0.0001) and PVR (MD −1.40 Wood units, 95% CI [−1.97, −0.82], p &lt; 0.00001). There was a significant increase in the cardiac index as well (MD 0.26 L/min/m2, 95% CI [0.14, 0.39], p &lt; 0.0001). There were fewer patients who had NYHA class III/lV symptoms, with an odds ratio of 0.55 (95% CI [0.30, 1.01], p = 0.05). There was no significant difference in the 6MWD (12.62 m, 95% CI [−8.55, 33.79], p = 0.24), PaO2 (MD −2.20 mm Hg, 95% CI [−4.62, 0.22], p = 0.08), or BNP or NT-proBNP therapy (MD −0.15, 95% CI [−0.46, 0.17], p = 0.36). Conclusion: The use of PH-specific therapies in severe PH-COPD resulted in a significant reduction in mPAP and PVR and increased CI, with fewer patients remaining in NYHA functional class III/IV. However, no significant difference in the 6MWD, biomarkers of right ventricular dysfunction, or oxygenation was identified, demonstrating a lack of hypoxemia worsening with treatment. Further studies are needed to investigate the use of PH medications in patients with severe PH-COPD.</jats:p>","journal":"Journal of Cardiovascular Development and Disease","year":2023,"id":604432,"datarank":0.5230560164398432,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.15032001897164315,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.15032001897164315,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":11,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1440621,"name":"M Bakri Hammami","orcid":"0000-0003-3422-5163","position":1,"is_corresponding":false},{"id":1550794,"name":"Roxana Sulica","orcid":null,"position":2,"is_corresponding":false},{"id":1550795,"name":"Hemanth Boppana","orcid":null,"position":3,"is_corresponding":false},{"id":1314536,"name":"Zeinab Abdalla","orcid":null,"position":4,"is_corresponding":false},{"id":1550796,"name":"Charoo Iyer","orcid":null,"position":5,"is_corresponding":false},{"id":1550797,"name":"Hazem Taifour","orcid":null,"position":6,"is_corresponding":false},{"id":1550798,"name":"Chengu Niu","orcid":null,"position":7,"is_corresponding":false},{"id":1550799,"name":"Himanshu Deshwal","orcid":"0000-0003-2086-1281","position":8,"is_corresponding":false},{"id":1550793,"name":"Ahmed Elkhapery","orcid":"0000-0003-0705-1137","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Pulmonary Vasodilator Therapy in Severe Pulmonary Hypertension Due to Chronic Obstructive Pulmonary Disease (Severe PH-COPD): A Systematic Review and Meta-Analysis","abstract":"<jats:p>Background: Chronic obstructive pulmonary disease-associated pulmonary hypertension (PH-COPD) results in a significant impact on symptoms, quality of life, and survival. There is scant and conflicting evidence about the use of pulmonary hypertension (PH) specific therapy in patients with PH-COPD. Study Design and Methods: PubMed, OVID, CINAHL, Cochrane, Embase, and Web of Science were searched using various MESH terms to identify randomized controlled trials (RCTs) or observational studies investigating PH-specific therapies in patients with severe PH-COPD, defined by mean pulmonary artery pressure (mPAP) of more than 35 mm Hg or pulmonary vascular resistance (PVR) of more than 5 woods units on right heart catheterization. The primary outcome was a change in mPAP and PVR. Secondary outcomes were changes in six-minute walk distance (6MWD), changes in the brain-natriuretic peptide (BNP), New York Heart Association (NYHA) functional class, oxygenation, and survival. Results: Thirteen studies satisfied the inclusion criteria, including a total of 328 patients with severe PH-COPD. Out of these, 308 patients received some type of specific therapy for PH. There was a significant reduction in mPAP (mean difference (MD) −3.68, 95% CI [−2.03, −5.32], p &lt; 0.0001) and PVR (MD −1.40 Wood units, 95% CI [−1.97, −0.82], p &lt; 0.00001). There was a significant increase in the cardiac index as well (MD 0.26 L/min/m2, 95% CI [0.14, 0.39], p &lt; 0.0001). There were fewer patients who had NYHA class III/lV symptoms, with an odds ratio of 0.55 (95% CI [0.30, 1.01], p = 0.05). There was no significant difference in the 6MWD (12.62 m, 95% CI [−8.55, 33.79], p = 0.24), PaO2 (MD −2.20 mm Hg, 95% CI [−4.62, 0.22], p = 0.08), or BNP or NT-proBNP therapy (MD −0.15, 95% CI [−0.46, 0.17], p = 0.36). Conclusion: The use of PH-specific therapies in severe PH-COPD resulted in a significant reduction in mPAP and PVR and increased CI, with fewer patients remaining in NYHA functional class III/IV. However, no significant difference in the 6MWD, biomarkers of right ventricular dysfunction, or oxygenation was identified, demonstrating a lack of hypoxemia worsening with treatment. Further studies are needed to investigate the use of PH medications in patients with severe PH-COPD.</jats:p>","is_dataset_classified":null,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38132665","pmcid":null,"openalex_id":"https://openalex.org/W4389883054","authors":[],"funders":[],"total_grants":0,"fwci":1.0885,"citation_percentile":0.70432357,"influential_citations":0,"citation_trend":[{"year":2024,"count":5},{"year":2025,"count":5},{"year":2026,"count":1}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://www.mdpi.com/2308-3425/10/12/498/pdf?version=1702862693","host_type":"journal"},{"url":"https://www.mdpi.com/2308-3425/10/12/498/pdf?version=1702862693","host_type":"publisher"},{"url":"https://www.mdpi.com/2308-3425/10/12/498/pdf","host_type":"publisher"},{"url":"https://doi.org/10.3390/jcdd10120498","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38132665","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10743410","host_type":"repository"},{"url":"https://doaj.org/article/98e60689cd6a43e0a0c76a1886c204e0","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10743410/pdf/jcdd-10-00498.pdf","host_type":"repository"}],"fields_of_study":["Pulmonary Hypertension Research and Treatments","Chronic Obstructive Pulmonary Disease (COPD) Research","Cardiovascular Function and Risk Factors"],"mesh_terms":[],"keywords":["Medicine","Pulmonary hypertension","COPD","Internal medicine","Cardiology","Pulmonary artery","Vascular resistance","Brain natriuretic peptide","Heart failure","Blood pressure"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-30T00:08:15.501563Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}