Safety and efficacy of targeted pharmacotherapy in elderly patients with pulmonary arterial hypertension
M Kramer, M Hellmich, T KramerAbstract
Background/Introduction
Pulmonary arterial hypertension (PAH) is increasingly diagnosed in elderly patients, who frequently present with cardiovascular comorbidities, less severe haemodynamic impairment and reduced tolerance to therapy. Despite their growing clinical relevance, elderly and very elderly patients remain underrepresented in pivotal clinical trials.
Purpose
To evaluate the safety and efficacy of targeted pharmacotherapy in elderly and very elderly patients with PAH compared with younger individuals.
Methods
In this retrospective single-centre study, 147 patients with newly diagnosed PAH receiving targeted therapy were analysed. Patients were stratified into three age groups: younger (<65 years), elderly (65–74 years) and very elderly (≥75 years). Clinical outcomes, echocardiographic parameters, haemodynamics and risk status were assessed at baseline and during 12-month follow-up.
Results
Elderly and very elderly patients were less likely to receive upfront combination therapy and demonstrated smaller overall clinical and haemodynamic improvements compared with younger patients. However, key prognostic haemodynamic parameters, including cardiac index, stroke volume index and pulmonary arterial compliance, improved to a similar extent across all age groups. Adverse effects occurred more frequently in older patients (p = 0.024) but were predominantly minor.
Conclusions
Targeted pharmacotherapy was effective and generally well tolerated in elderly patients with PAH. Although the overall treatment response was attenuated compared with younger individuals, clinically relevant haemodynamic improvements were observed across all age groups. These findings support individualized treatment strategies in experienced centres and underscore the importance of haemodynamic monitoring for follow-up risk assessment in elderly patients. Age-specific treatment recommendations and randomized trials in this population are warranted.