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Volume 15
Issue 13
10.3390/jcm15134924
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Sequential Add-On Therapy Modifies Mortality Risk Stratification in Group 1.4 Pulmonary Arterial Hypertension: A Real-World, Single-Center Retrospective Cohort Study from Mexico

by
Arturo Cortes-Telles
*,
Yuliana Valeria Priego-Escamilla
,
Diana Lizbeth Ortíz-Farias
,
Saúl Vázquez-López
,
Yuri Noemí Pou-Aguilar
and
Esperanza Figueroa-Hurtado
Clínica de Enfermedades Respiratorias del Hospital Regional de Alta Especialidad de la Península de Yucatán, IMSS-Bienestar, Mérida 97130, Mexico
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(13), 4924; https://doi.org/10.3390/jcm15134924 (registering DOI)
Submission received: 22 May 2026 / Revised: 19 June 2026 / Accepted: 22 June 2026 / Published: 24 June 2026
(This article belongs to the Special Issue Clinical Research on Pulmonary Hypertension and Its Complications)
Versions Notes

Abstract

Background: Dynamic risk stratification is fundamental to the modern management of pulmonary arterial hypertension (PAH). However, data on the impact of sequential add-on therapy in patients with Group 1.4 PAH—particularly in Latin American populations—remains limited. This study evaluated changes in risk classification using COMPERA 2.0 and REVEAL Lite 2 scores in patients treated with endothelin receptor antagonist (ERA) and phosphodiesterase type 5 inhibitor (PDE5i) combination therapy (macitentan + sildenafil) at a referral center in Mexico. Methods: In this single-center, retrospective cohort study, 25 patients with a confirmed diagnosis of PAH between 1st January 2022 and 31st December 2024 were evaluated at baseline and after 24 weeks of treatment. Clinical, functional, and biochemical parameters were recorded. Within-patient changes were analyzed using the Wilcoxon signed-rank test, and agreement between risk assessment tools was assessed using Spearman’s correlation coefficient. Results: At 24 weeks, patients demonstrated significant improvement in World Health Organization functional class (p = 0.002) and a significant reduction in brain natriuretic peptide levels (p = 0.003). Both COMPERA 2.0 and REVEAL Lite 2 scores showed a consistent shift toward lower-risk categories. A strong concordance between the two tools was observed. Conclusions: Sequential add-on ERA + PDE5i therapy was associated with meaningful improvement in risk stratification among patients with Group 1.4 PAH. These findings support the clinical utility of simplified, noninvasive risk assessment tools in real-world settings, particularly in resource-constrained environments.
Keywords: sequential add-on therapy; COMPERA 2.0; Eisenmenger syndrome; pulmonary arterial hypertension; REVEAL Lite 2 sequential add-on therapy; COMPERA 2.0; Eisenmenger syndrome; pulmonary arterial hypertension; REVEAL Lite 2

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MDPI and ACS Style

Cortes-Telles, A.; Priego-Escamilla, Y.V.; Ortíz-Farias, D.L.; Vázquez-López, S.; Pou-Aguilar, Y.N.; Figueroa-Hurtado, E. Sequential Add-On Therapy Modifies Mortality Risk Stratification in Group 1.4 Pulmonary Arterial Hypertension: A Real-World, Single-Center Retrospective Cohort Study from Mexico. J. Clin. Med. 2026, 15, 4924. https://doi.org/10.3390/jcm15134924

AMA Style

Cortes-Telles A, Priego-Escamilla YV, Ortíz-Farias DL, Vázquez-López S, Pou-Aguilar YN, Figueroa-Hurtado E. Sequential Add-On Therapy Modifies Mortality Risk Stratification in Group 1.4 Pulmonary Arterial Hypertension: A Real-World, Single-Center Retrospective Cohort Study from Mexico. Journal of Clinical Medicine. 2026; 15(13):4924. https://doi.org/10.3390/jcm15134924

Chicago/Turabian Style

Cortes-Telles, Arturo, Yuliana Valeria Priego-Escamilla, Diana Lizbeth Ortíz-Farias, Saúl Vázquez-López, Yuri Noemí Pou-Aguilar, and Esperanza Figueroa-Hurtado. 2026. "Sequential Add-On Therapy Modifies Mortality Risk Stratification in Group 1.4 Pulmonary Arterial Hypertension: A Real-World, Single-Center Retrospective Cohort Study from Mexico" Journal of Clinical Medicine 15, no. 13: 4924. https://doi.org/10.3390/jcm15134924

APA Style

Cortes-Telles, A., Priego-Escamilla, Y. V., Ortíz-Farias, D. L., Vázquez-López, S., Pou-Aguilar, Y. N., & Figueroa-Hurtado, E. (2026). Sequential Add-On Therapy Modifies Mortality Risk Stratification in Group 1.4 Pulmonary Arterial Hypertension: A Real-World, Single-Center Retrospective Cohort Study from Mexico. Journal of Clinical Medicine, 15(13), 4924. https://doi.org/10.3390/jcm15134924

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