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Blood pressure control in continuous flow left ventricular assist devices: efficacy and impact on adverse events
Brent C Lampert1, Chad Eckert2, Stephanie Weaver1
1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Managing hypertension in continuous flow (CF) left ventricular assist device (LVAD) patients is crucial. Blood pressure control was achieved with antihypertensives, reducing neurologic events and aortic insufficiency progression in CF LVAD recipients.
Area of Science:
- Cardiology
- Medical Devices
- Hypertension Management
Background:
- Continuous flow (CF) left ventricular assist devices (LVADs) are sensitive to afterload, making hypertension a concern.
- Uncontrolled hypertension in CF LVAD patients may increase risks of aortic insufficiency (AI) and stroke.
- Optimal blood pressure management strategies post-CF LVAD implantation are not well-established.
Purpose of the Study:
- To evaluate the impact of a predefined blood pressure management protocol in CF LVAD patients.
- To assess the rates of aortic insufficiency (AI) and stroke in relation to blood pressure control.
- To determine the antihypertensive medication requirements for CF LVAD recipients.
Main Methods:
- A single-center study included 96 patients with CF LVADs (support > 30 days).
- Outpatient blood pressure was monitored at home via Doppler.
- Management followed an institutional protocol targeting a mean arterial pressure ≤ 80 mm Hg.
Main Results:
- A significantly higher rate of neurologic events occurred in patients not receiving antihypertensives compared to those who were (p = 0.009).
- Only 3% of patients with baseline mild or no AI progressed to moderate or severe AI.
- Most patients on antihypertensives (74%) required one or two medications.
Conclusions:
- Blood pressure control is achievable in CF LVAD patients using a standardized protocol.
- Antihypertensive therapy in CF LVAD patients is associated with reduced neurologic events.
- The majority of CF LVAD patients require one to two antihypertensive medications for adequate blood pressure control.
Background:
Continuous flow (CF) left ventricular assist devices (LVAD) are afterload sensitive and therefore pump performance is affected by hypertension. In addition, poorly controlled hypertension may increase the risk of aortic insufficiency (AI) and stroke. Blood pressure regimens after CF LVAD have not been studied and their impact on rates of AI and stroke are unknown.
Methods:
Patients who had CF LVAD at a single center and were supported greater than 30 days were included. Blood pressure was monitored at home by Doppler. Outpatient management of blood pressure was conducted according to a predefined institutional protocol (target mean arterial pressure ≤ 80 mm Hg).
Results:
A total of 96 patients were included. At the end of follow-up, 25 patients were not on an antihypertensive drug, of these 9 died. Of the 74% receiving antihypertensives, 54% required 1 medication, 34% were on 2, 10% were on 3, and 3% were on 4 or more. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (85% of patients on an antihypertensive) and beta blockers (30%) were the most commonly prescribed medications. There was a significantly higher neurologic event rate in those on no antihypertensives compared with those on antihypertensives (p = 0.009). Only 3% of patients with no or mild AI at baseline progressed to develop moderate or greater AI after a mean of 201 days of follow-up.
Conclusions:
Blood pressure control can be achieved in patients with CF LVADs, with the majority of patients requiring only 1 or 2 antihypertensives.
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