Dual pulmonary Hypertension Therapy Before Balloon Pulmonary Angioplasty Improves Outcomes: Study
Netherlands: In patients with chronic thromboembolic pulmonary hypertension (CTEPH), pretreatment with dual pulmonary hypertension-targeted therapy before balloon pulmonary angioplasty (BPA) was associated with fewer thoracic complications and greater improvements in clinical status and hemodynamic parameters compared with PH-targeted monotherapy. These findings suggest that dual therapy may optimize patient outcomes and procedural safety before BPA. The study was published in CHEST by D. P. Staal and colleagues.
Chronic thromboembolic pulmonary hypertension is a severe form of pulmonary hypertension caused by persistent blood clots in the pulmonary arteries. Balloon pulmonary angioplasty is an established treatment for patients who are ineligible for surgery or remain symptomatic despite therapy. While PH-targeted medications before BPA have been linked to reduced procedural risks, data comparing monotherapy and dual therapy have been limited.
To compare these approaches, researchers analyzed data from the Dutch BPA Registry, including consecutive patients with CTEPH who underwent BPA after pretreatment with either mono or dual PH-targeted therapy. Procedural complications, clinical outcomes, and pulmonary hemodynamic parameters were assessed from diagnosis through six months of follow-up.
The study included 169 patients with a mean age of 66 years; 53% were women, and 65% had WHO functional class III/IV symptoms. Of these, 93 patients received monotherapy, and 76 received dual PH-targeted therapy before BPA.
The study revealed the following findings:
- Patients pretreated with dual PH-targeted therapy experienced significantly fewer BPA-related thoracic complications per procedure than those receiving monotherapy (8.4% vs 19.6%).
- Higher N-terminal prohormone brain natriuretic peptide (NT-proBNP) levels were independently associated with an increased risk of thoracic BPA complications (OR: 1.40).
- Elevated right atrial pressure was an independent predictor of thoracic BPA complications (OR: 1.09).
- Pretreatment with PH-targeted monotherapy independently increased the risk of thoracic BPA complications compared with dual therapy (OR: 3.33).
- Patients receiving dual PH-targeted therapy showed greater improvement in six-minute walking distance over six months of follow-up.
- Dual therapy was associated with larger improvements in cardiac index compared with monotherapy.
- Patients pretreated with dual therapy experienced greater reductions in pulmonary vascular resistance (PVR) during follow-up.
The researchers concluded that pretreatment with dual PH-targeted therapy before BPA may offer meaningful advantages for patients with CTEPH. Beyond reducing procedure-related thoracic complications, the strategy was associated with superior functional and hemodynamic outcomes, supporting its potential role in optimizing patient preparation and improving overall treatment results.
Reference:
Staal, D., Lely, R., Breuning, A., Van Thor, M., Peper, J., Nossent, E., Van Kuijk, J., Aman, J., Van den Heuvel, D., Van Es, J., Vonk-Noordegraaf, A., Boerman, S., Bogaard, H., Mager, J., Beijk, M., & Post, M. (2026). Pretreatment with mono or dual PH-targeted medical therapy in patients undergoing balloon pulmonary angioplasty: Effect on complications and clinical outcomes. CHEST. https://doi.org/10.1016/j.chest.2026.04.048
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