Pulmonary hypertension: a contraindication to the use of β-adrenoceptor blocking agents

Supraventricular tachycardia (SVT) is a rare but important complication of pulmonary arterial hypertension. beta-Adrenoceptor blocking agents are commonly used to treat SVT, but they are potentially dangerous in the context of pulmonary arterial hypertension. Their negative inotropic and chronotropic effects are poorly tolerated in this condition, where cardiac reserve is compromised by a reduced and fixed stroke volume, and their administration can result in significant cardiorespiratory compromise. This is not a new discovery, but it is nonetheless poorly recognised in day-to-day clinical practice.