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Background  Previous studies indicate that patients with pulmonary arterial hypertension (PAH) carrying a mutation in the bone morphogenetic protein receptor type 2 ( BMPR2 ) gene, develop the disease 10 years earlier than non-carriers, and have a more severe hemodynamic compromise at diagnosis. A recent report has suggested that this may only be the case for females and that patients with missense mutations in  BMPR2  gene have more severe disease than patients with truncating mutations.    Methods  We reviewed data from all patients with PAH considered as idiopathic and patients with a family history of PAH, who underwent genetic counselling in the French PAH network between January, 1 st  2004 and April, 1 st  2010. We compared clinical, functional, and hemodynamic characteristics between carriers and non-carriers of a  BMPR2  mutation, according to gender or  BMPR2  mutation type.    Results  PAH patients carrying a  BMPR2  mutation (n = 115) were significantly younger at diagnosis than non-carriers (n = 267) (35.8 ± 15.4 and 47.5 ± 16.2 respectively, p < 0.0001). The presence of a  BMPR2  mutation was associated with a younger age at diagnosis in females (36.4 ± 14.9 in  BMPR2  mutation carriers and 47.4 ± 15.8 in non-carriers, p < 0.0001), and males (34.6 ± 16.8 in  BMPR2  mutation carriers and 47.8 ± 17.1 in non-carriers, p < 0.0001).  BMPR2  mutation carriers had a more severe hemodynamic compromise at diagnosis, but this was not influenced by gender. No differences in survival and time to death or lung transplantation were found in male and female PAH patients carrying a  BMPR2  mutation. No differences were observed in clinical outcomes according to the type of  BMPR2  mutations (missense, truncating, large rearrangement or splice defect).    Conclusion  When compared to non-carriers,  BMPR2  mutation carriers from the French PAH network are younger at diagnosis and present with a more severe hemodynamic compromise, irrespective of gender. Moreover,  BMPR2  mutation type had no influence on clinical phenotypes in our patient population.

Absence of influence of gender and BMPR2 mutation type on clinical phenotypes of pulmonary arterial hypertension