Article Abstract

Systemic blood pressure trends and antihypertensive utilization following continuous-flow left ventricular assist device implantation: an analysis of the interagency registry for mechanically assisted circulatory support

Authors: Adham Elmously, Andreas R. de Biasi, Donald A. Risucci, Berhane Worku, Evelyn M. Horn, Arash Salemi

Abstract

Background: Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps.
Methods: We identified all CF-LVAD implantations in patients older than 18 years from 2006–2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status were tabulated, extending up to 5 years following implantation.
Results: A total of 10,329 CF-LVAD implantations were included for study. Post-implant, SBPs increased rapidly during the first 3 months but plateaued thereafter; AH utilization mirrored this trend. By 6 months, mean MAPs climbed 12.2% from 77.6 mmHg (95% CI: 77.4–77.8) pre-implantation to 87.1 mmHg (95% CI: 86.7–87.4) and patients required a mean of 1.8 AH medications (95% CI: 1.75–1.78) —a 125% increase from AH use at 1-week post-implantation (0.8 AHs/patient, 95% CI: 0.81–0.83) but a 5.3% decrease from pre-implant utilization (1.9 AHs/patient, 95% CI: 1.90–1.92). Once medication changes stabilized, the most common AH regimens were lone beta blockade (15%, n=720) and a beta blocker plus an ACE inhibitor (14%, n=672).
Conclusions: SBP rises rapidly after CF-LVAD implantation, stabilizing after 3 months, and is matched by concomitant changes in AH utilization; this AH use has increased over consecutive implant years.