Blood pressure control in continuous flow left ventricular assist devices: efficacy and impact on adverse events.
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.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Brent C
BC
Lampert
Artificial Heart Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Chad
C
Eckert
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Stephanie
S
Weaver
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ana
A
Scanlon
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Kathy
K
Lockard
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Carrie
C
Allen
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Nicole
N
Kunz
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Christian
C
Bermudez
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Jay K
JK
Bhama
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Michael A
MA
Shullo
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Robert L
RL
Kormos
Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Mary Amanda
MA
Dew
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: teutebergjj@upmc.edu.
Jeffrey J
JJ
Teuteberg
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000517:prevention & control; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents
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