Pulmonary hypertension in the elderly: Insights from a new group of patients with an old disease

A RECOPILAR subgroup analysis

Abstract

Contemporary registries show a demographic transition towards older age in pulmonary hypertension (PH). The objectives of this subgroup analysis were to evaluate the clinical profile, management and outcome in older adults with PH in Argentina. Methods: The collaborative RECOPILAR registry included 399 PH patients between July 2014 to October 2016. Older adults were identified by age ≥65 years (elderly pulmonary hypertension patients - EPHP) and compared with <65 years (non-elderly pulmonary  hypertension patients - NEPHP). Results: The prevalence of EPHP was 19% (n=76). In the EPHP and NEPHP groups, the age was 73±6 vs 41±15 years and 86 vs 77% were women (p=ns). Older adults more frequently had arterial hypertension (p=0.012), dyslipidemia (p=0.015) and diabetes (p=0.033). The main etiologies of PH were idiopathic (34.2 vs 41.4%; p=ns); associated with connective tissue disease (44.7 vs 18.9%; p<0.001) and congenital heart disease (17.1 vs 27.2% p=0.067). Clinical characteristics were similar, with a predominance of baseline functional class III-IV (72 vs 63% p=ns), lower history of syncope (2.6 vs 15.8%; p=0.002), less distance in
six-minute walking test and lower pulmonary pressures in EPHP than NEPHP. The use of specific therapy was similar in both groups. Three-year survival in EPHP vs NEPHP was 65 vs 80% (p=0.035), and age ≥65 years was an independent predictor of mortality (HR 2.43; 95% CI 1.29-4.57; p=0.006). Conclusions: In Argentina, 1 out 5 patients with PH is elderly. They present more comorbidities, similar clinical severity, better hemodynamics, worse functional capacity and receive specific therapy similar to younger subjects. Age ≥65 years was an independent risk marker.