According to the 2015 ESC guidelines for diagnosis and treatment of pulmonary hypertension (PH), the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin-II receptor blockers (ARBs), beta-blockers (BBs) and ivabradine (Iva) is not recommended in patients with pulmonary artery hypertension (PAH), unless required by co-morbidities, because no convincing data are available on the efficacy and safety of such drugs. However, real life patients are often different from those enrolled in big clinical trials, usually being older and having more comorbidities.
