A systematic study and meta-analysis published in Current Problems in Cardiology suggested that nonpharmacological treatments added to therapy may improve the pharmacological management of pulmonary hypertension (PH).

A progressive, potentially fatal condition known as pulmonary hypertension causes the heart to work harder and weaken over time due to pulmonary artery narrowing. Based on origin or comorbidity, the World Health Organization recognizes five main types of PH.

Chest pain, exhaustion, fainting or dizziness, and shortness of breath are typical signs of post-hypoxic hypotension. Heart failure and enlargement of the right side of the heart are possible side effects.

According to the authors, drugs can be effective at controlling PH symptoms, but they do not halt disease progression. In addition, “these drugs often come with side effects, complex administration, high costs, and lack of efficacy in completely reversing disease progression,” they wrote.

“Given these limitations, there is increasing interest in non-pharmacological interventions that might offer additional benefits or serve as alternatives to traditional treatments,” they added.

This study investigated the effects of combining alternative therapies with traditional PH treatment. It also pondered the possible processes by which these medicines could produce these outcomes and tried to evaluate the validity of earlier studies.

The study’s primary outcomes were respiratory arterial pressure, exercise capacity, quality of life, and death. Adverse effects and hospitalization rates were also evaluated.

First, the writers searched Scopus, Web of Science, EMBASE, Cochrane Library, and PubMed. Studies had to be able to distinguish between different types of interventions in order to be eligible, especially if multiple modalities were being used. This indicated whether there might be variations in effectiveness and ascertained whether a mix of treatments offered extra advantages.

Published between 2015 and 2024, the meta-analysis comprised 10 cohort studies, 5 case-control studies, and 15 randomized controlled trials. Two thousand individuals with PH of any kind who were at least 18 years old made up the study population. The authors noted that because patients with diverse PH etiologies may respond differently to dietary and exercise therapies, identifying involvement from each PH subgroup was crucial to assessing the effectiveness of the interventions.

The researchers evaluated ten psychosocial therapies, eight dietary interventions, and twelve structured exercise regimens in total; several studies combined different modalities.

Key study findings showed:   

• Exercise: increased exercise capacity as measured by the 6-minute walk distance (6MWD) with a mean increase of 45 meters (95% CI: 30-60 meters, P < .001). Participants in a structured exercise program also reported enhanced quality of life. Furthermore, patients participating in a structured exercise program showed an average increase of 0.8 L/min in cardiac output. The mechanisms thought to underlie these improvements included increased cardiac output, improved oxygen delivery to the tissues, better endothelial function, and greater skeletal muscle efficiency.
• Dietary changes: reduced mean pulmonary arterial pressure (mPAP) by an average of 4 mmHg (95% CI: 2 to 6 mmHg, P < .01). 
• Psychosocial support: significantly improved quality of life scores with a standardized mean difference of 0.45 (95% CI: 0.30 to 0.60, P < .001) on the Minnesota Living with Heart Failure Questionnaire. Notably, psychosocial therapies also reduced anxiety and depression.   

The authors said, for instance, that differing types of interventions and varying subgroups across the included studies make it difficult to generalize their results to a broader PH population. Furthermore, the data identified variable risks of bias, a factor shown to influence the reliability of findings in previous meta-analyses.

Still, the authors believe their study illustrates the potential of alternative therapies to complement traditional treatment of PH.

“However, the effectiveness and safety of these interventions need further exploration, particularly in comprehensive clinical settings,” they concluded.