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

Figures

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  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.

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  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.

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  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.

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  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.

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  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.