Improving Treatment Personalization of Pulmonary Hypertension Associated With Diastolic Heart Failure

Study Overview
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Brief Summary
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Heart failure with preserved ejection fraction (HFpEF), is one of the leading causes of pulmonary hypertension (PH). Despite the severity of this disease, no established treatments exist for this class of PH. Nebivolol is a drug used in high blood pressure and heart failure, but not used in patients with PH. Due to some additional properties it possesses, the investigators believe nebivolol will improve disease severity in patients with PH associated with HFpEF. The hypothesis of this research study is that nebivolol improves PH severity in patients with HFpEF, as measured by hemodynamic and clinical parameters.

Detailed Description
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This research study will be a prospective, open-label 18-week clinical study of nebivolol in patients with PH associated with HFpEF. Patients will be identified in clinic based on echocardiogram (TTE) and right heart catheterization (RHC) results (both part of standard clinical care) indicating PH and HFpEF.

Official Title
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Improving Treatment Personalization of Pulmonary Hypertension Associated With Diastolic Heart Failure

Conditions
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Pulmonary Hypertension, Diastolic Heart Failure, Heart Failure With Preserved Ejection Fraction

Intervention / Treatment
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* Drug: Nebivolol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults (≥ 18 years of age) with World Health Organization Group 2 Pulmonary Hypertension (Mean pulmonary artery pressure ≥ 25 mmHg and pulmonary capillary wedge pressure ≥ 15 mmHg) New York Heart Association class II-IV symptoms Left ventricular ejection fraction (LVEF) ≥ 45% Exclusion Criteria: Other causes of heart failure other than diastolic dysfunction, such as restrictive cardiomyopathy or infiltrative cardiomyopathy Women who are pregnant or nursing Liver cirrhosis, Primary valvular disease Acute coronary syndrome Causes of PH other than that of heart failure, such as: chronic thromboembolic PH, sickle-cell disease, or sarcoidosis Severe bradycardia or greater than 1st degree heart block Decompensated heart failure Current use of a third generation beta-blocker (nebivolol, carvedilol, or labetalol) or high dose of any beta-blockers (greater than 100 mg daily of metoprolol, or equivalent)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nebivolol<br>Participants will be started at 2.5 mg of nebivolol by mouth daily if on a beta-blocker the dose will start at 5mg, and titrated up to 10 mg daily, as tolerated. | Drug: Nebivolol<br>* Nebivolol will be started at 2.5 mg by mouth daily if on a beta-blocker the dose will start at 5mg, and titrated up to 10 mg daily, as tolerated.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Pulmonary Vascular Pressure | Difference between baseline and 18 week mean pulmonary artery pressure and pulmonary artery wedge pressure | baseline - 18 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in 6-minute Walk Distance | Difference in 6-minute walk distance between baseline and 18 weeks. | baseline - 18 weeks |