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. 2024 Sep 15;15(9):6014-6021.
doi: 10.19102/icrm.2024.15091. eCollection 2024 Sep.

Permanent Pacing Reduces Blood Pressure in Older Patients with Drug-resistant Hypertension: A New Pacing Paradigm?

Bich Lien Nguyen  1 , Michael H Burnam  2   3 , Francesco Accardo  1 , Angela Angione  1 , Roberto Scacciavillani  4 , Carly Pierson  5 , Eli S Gang  5   6
Affiliations

Permanent Pacing Reduces Blood Pressure in Older Patients with Drug-resistant Hypertension: A New Pacing Paradigm?

Bich Lien Nguyen et al. J Innov Card Rhythm Manag. .

Abstract

Hypertension (HTN) is a major contributor to cardiovascular mortality. Many patients with drug-resistant hypertension (DRH) also require permanent pacing (PP). This large retrospective study evaluated the effect of PP for conventional PP indications in older patients with DRH. We reviewed the charts of 176 patients with dual-chamber PP and DRH. The effects of PP on systolic and diastolic blood pressure (sBP and dBP), the number of HTN-related medications, and left ventricular ejection fraction (LVEF) were assessed at 6 months post-implantation and compared with pre-implantation values. Patients were followed up with for ≥72 months. Patients with a decline of >5 mmHg in sBP and decrease in at least one anti-HTN medication were defined as responders (126/176; P < .01). The mean decline in sBP was 9 mmHg, while that in dBP was 3 mmHg (P < .001 for both). Among responders, optimal reductions in sBP, dBP, and medications were seen at a stratification of >50% atrial pacing and <40% ventricular pacing (-12, -6.3, and -1.6, respectively). When right ventricular pacing of <50% was used for dichotomizing, the optimal atrial/ventricular pacing stratification was atrial pacing > 50% and ventricular pacing < 40% (-11.3, -6.3, and -1.6, respectively). A relationship between increasing atrial pacing and a decline in sBP was noted but did not reach statistical significance. However, of those responders who had a >10-mmHg decline in sBP, the majority were paced between 60%-100% in the atria. The LVEF did not change post-PP in either group. In conclusion, PP results in significant improvement in BP control. The observed association warrants further investigation.

Keywords: Drug-resistant hypertension; dual-chamber pacing; hypertension; permanent pacing.

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Conflict of interest statement

Dr. Burnam is a shareholder and officer of Baropace, Inc. Dr. Gang is a shareholder of Baropace, Inc. The other authors report no conflicts of interest for the published content. No funding information was provided.

Figures

Figure 1:
Figure 1:
Differences in mean blood pressure (pre-/post-pacing). A “bar plot” illustrating mean blood pressure (before and after permanent pacing) in both groups of patients (responders and non-responders). Abbreviations: dBP, diastolic blood pressure; sBP, systolic blood pressure.
Figure 2:
Figure 2:
Distribution of systolic blood pressure (sBP) (mmHg) before and after pacing. A Wilcoxon signed-rank test was used for comparing the distribution of sBP among responders (n = 126) before and after the initiation of permanent pacing (P < .001). Note the significant “shift to the left” of the sBP curve (dotted line) following pacing among the responders. Abbreviation: sBP, systolic blood pressure.
Figure 3:
Figure 3:
Relationship between pacing, decline in systolic blood pressure (sBP), and changes in the number of medications. A majority of the responders had either a decline in sBP of ≥5 mmHg and a reduction by at least one medication or a decline in sBP without a change in medication. Only a small number of responders (n = 8) had a reduction in medication number without a decline in sBP of ≥5 mmHg. Among the 50 non-responders, 9 patients had an increase in the number of medications taken after permanent pacing. The number of lines in the graph does not correspond to all the patients, as many patients who had similar responses are grouped into single graph lines for the sake of clarity. Abbreviation: sBP, systolic blood pressure.
Figure 4:
Figure 4:
A: Plot describing the correlation between reduction in systolic blood pressure and percent atrial pacing among responders. The positive slope does not reach statistical significance (R2 = 0.022; P = .09). B: A more robust correlation (still statistically not significant) between systolic blood pressure reduction and percent atrial pacing when the blood pressure decline is stratified at a decline of >10 mmHg (R2 = 0.086; P = .19) is displayed. Abbreviation: sBP, systolic blood pressure.
Figure 5:
Figure 5:
Distribution of atrial pacing among patients who experienced a >10-mmHg decline in sBP. The group of responders who manifested a reduction in sBP of >10 mmHg (n = 21) is divided into bins of percentage of atrial pacing. As illustrated, most of the patients with this response in sBP were found within the two pacing bins that represent >60% atrial pacing. Abbreviation: A-pacing, atrial pacing.
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