Nguyen Bich Lien, Burnam Michael H, Accardo Francesco, Angione Angela, Scacciavillani Roberto, Pierson Carly, Gang Eli S
Cardiology Department, Sapienza University, Rome, Italy.
BaroPace, Ashland, OR, USA.
J Innov Card Rhythm Manag. 2024 Sep 15;15(9):6014-6021. doi: 10.19102/icrm.2024.15091. eCollection 2024 Sep.
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; < .01). The mean decline in sBP was 9 mmHg, while that in dBP was 3 mmHg ( < .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.
高血压（HTN）是心血管疾病死亡率的主要促成因素。许多耐药性高血压（DRH）患者也需要永久性起搏（PP）。这项大型回顾性研究评估了PP对老年DRH患者常规PP适应症的影响。我们回顾了176例双腔PP和DRH患者的病历。在植入后6个月评估PP对收缩压和舒张压（sBP和dBP）、HTN相关药物数量以及左心室射血分数（LVEF）的影响，并与植入前的值进行比较。对患者进行了≥72个月的随访。sBP下降>5 mmHg且至少一种抗高血压药物减少的患者被定义为有反应者（126/176；<0.01）。sBP的平均下降为9 mmHg，而dBP的平均下降为3 mmHg（两者均<0.001）。在有反应者中，当心房起搏>50%且心室起搏<40%时，sBP、dBP和药物的最佳降低值分别为-12、-6.3和-1.6。当使用<50%的右心室起搏进行二分法时，最佳心房/心室起搏分层为心房起搏>50%且心室起搏<40%（分别为-11.3、-6.3和-1.6）。注意到心房起搏增加与sBP下降之间存在关联，但未达到统计学意义。然而，在那些sBP下降>10 mmHg的有反应者中，大多数心房起搏率在60%-100%之间。两组患者PP后LVEF均未改变。总之，PP可显著改善血压控制。观察到的关联值得进一步研究。
