[The treatment of excessive arterial hypertension by a permanent cardiac pacemaker system: a case report concerning the possibility to influence the disturbed harmonization between the heart and the arterial system (author's transl)].

In a 63 year old female patient with a history of longstanding arterial hypertension the implantation of a permanent cardiac pacemaker system resulted in a drastic reduction of the elevated blood pressure values, allowing to reduce the formerly necessary high dosage of antihypertensive drugs. It can be assumed that in the case presented the insertion of the permanent pacemaker leads to several hemodynamic changes: firstly, the heart rate is elevated slightly, secondly, the course of the ejection of the stroke volume is changed and consequently the contour of the pulse wave. Especially the latter factor may have an influence on various regulating mechanisms of the circulatory system and thereby on the lowering of the arterial blood pressure and the consecutive reduction of the hypertrophy of the left ventricle. Most probably the baroreceptor reflex system may be of additional great importance. In addition the "desynchronization" of the spread of excitation by the cardiac pacer might be assumed to change the action of the heart in the beginning of the ejection phase into a "softer" way of pumping. The alteration of a rather "rigid" pump (during normal excitation) into a "soft" pump (during desynchronized excitation) thus may lead to a lowering of the arterial pressure a) by decreasing the speed of ejection of the stroke volume and b) by improving the matching between the heart and the arterial "Windkessel".