Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Device Technology D-PO02 - Poster Session II (ID 47) Poster

D-PO02-099 - Permanent Pacing And Decline In Blood Pressure In Patients With Drug Resistant Hypertension: A Large Retrospective Study (ID 1014)


Background: We previously reported improvement in the control of drug resistant hypertension (DRH) in a small group of elderly patients with concomitant permanent pacing (PP). The initial observation well correlated with atrial pacing. In this study, we report a larger group of patients and with extended follow-up period to 6 years.
Objective: To retrospectively evaluate the longterm effects of PP on DRH and on left ventricular function (LVEF) in a large group of permanently paced patients.
Methods: We retrospectively reviewed the charts of 176 patients who had dual chamber PM and DRH, followed in a large University based pacemaker clinic. Effects of PP on systolic and diastolic BP (SBP and DBP), number of drugs taken and LVEF, were assessed at various follow-up durations. Extent of pacing in each chamber was also analyzed and correlated with response or non-response as measured by drop in BP and decline in number of drugs used.
Results: A total of 176 patients with DRH and PP were found, mean age 75+7.1; 24% were females. At follow-up (64+57 months), 122 (69%) were responders, with a mean reproducible decline in SBP (9.7+6.8 mmHg, p<.01), and a decline in DBP (3.8+6.8 mmHg, p<.02). Number of medications declined among responders (3.29 to 2.75, p<.01) but not among non-responders. Percent right atrial (RA) pacing was correlated with a significant drop in SBP (47%+36 for responders, 33%+37 for non-responders, p<.01) as well as with reduction in number of medications. Percent right ventricular (RV) pacing was not correlated with decline in BP or number of medications taken. The LVEF improved significantly among responders (54.5+4% to 55.8+3%, p<.01), but not among non-responders. Responders tended to be males (p<.05); no correlation was found between response to PP and patient age or duration of treatment.
Conclusion: In this larger and younger patient cohort with longer follow-up, we confirmed our prior observations of a highly significant correlation between PP and a decline in SBP, DBP, and number of drugs needed. The correlation with atrial pacing, as well as the slight but significant increase in LVEF among responders, suggests that this phenomenon is not simply a result of pacing induced decline in ventricular systolic function. These observations warrant further study.