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Elucidating the Relationship Between Pacemaker Heart Rates and Pulse Pressure: A Clue to Optimal Programming in

Muhtashim Mian1, Ahmed T Moustafa1, Habib R Khan1

  • 1Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada.

CJC Open
|March 2, 2026
PubMed

Insights

Increasing heart rate (HR) in pacemaker patients can lower pulse pressure (PP), a marker of vascular stiffness. This may improve hemodynamics and potentially reduce stroke risk in older adults.

Area of Science:

  • Cardiology
  • Geriatrics
  • Vascular Medicine

Background:

  • High pulse pressure (PP) and low diastolic blood pressure (DBP) indicate vascular stiffness, increasing stroke and cognitive impairment risk.
  • Increasing resting heart rate (HR) may reduce PP and improve cerebral perfusion in pacemaker patients.
  • This study investigated the impact of elevated HR on PP in patients with elevated vascular risk.

Purpose of the Study:

  • To examine the effect of increasing resting heart rate (HR) on pulse pressure (PP) in older patients with pacemakers and vascular risk.

Main Methods:

  • A cross-sectional interventional study included 21 patients (age > 65) with dual-chamber pacemakers.
  • Hemodynamic parameters were measured using Finapres NOVA at baseline and with HR increments up to 100 bpm.
  • Analysis focused on changes in PP, systolic BP, DBP, and cardiac output with varying HRs.

Main Results:

  • Increasing HR significantly reduced PP (p < 0.001) from 71 mmHg at 60 bpm to 53 mmHg at 100 bpm.
  • No significant changes were observed in systolic BP, DBP, or cardiac index across different HRs.
  • Most patients experienced decreased PP at higher HRs, with no adverse events or symptoms.

Conclusions:

  • Increasing HR to 70 bpm reduced PP in most pacemaker patients, suggesting a method to improve hemodynamics in those with poor vascular compliance.
  • Optimizing HR settings may reduce PP and mitigate risks of cognitive decline or stroke.
  • Further research is needed to assess risks of pacemaker-induced cardiomyopathy with frequent ventricular pacing.
Abstract

Keywords:
cardiac outputcerebral perfusionpacemakerpacing heart ratespulse pressure

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