Long-Term Effects of Paced Heart Rate on Central Blood Pressure in Patients with Sinus Node Dysfunction and Hypertension: A Randomised Crossover Study.
Long-term pacing at a moderately accelerated physiological rate (DDD 75 bpm) may be associated with lower central systolic BP than pacing at a slightly bradycardic rate (DDD 55 bpm) in older permanently paced SND patients with hypertension.
Key Findings
Results
Central systolic BP (the primary outcome) was higher during DDD 55 bpm pacing than during DDD 75 bpm pacing after eight weeks.
Mean central systolic BP was 127.8 ± 13.4 mmHg at DDD 55 versus 121.3 ± 10.6 mmHg at DDD 75 (p = 0.04).
Design was a prospective, single-centre, randomised, single-blind, exploratory crossover trial.
Each participant completed two eight-week periods (DDD 55 and DDD 75 bpm) separated by a two-week washout.
Measurements were taken non-invasively with an oscillometric cuff-based device (SphygmoCor XCEL).
Results
Systolic BP amplification was lower at DDD 55 bpm than at DDD 75 bpm.
Systolic BP amplification (peripheral systolic BP minus central systolic BP) was 8.5 ± 3.2 mmHg at DDD 55 versus 10.1 ± 2.9 mmHg at DDD 75 (p = 0.02).
Results
Pulse pressure amplification was lower at DDD 55 bpm than at DDD 75 bpm.
PP amplification (peripheral PP/central PP) was 1.2 ± 0.1 at DDD 55 versus 1.3 ± 0.1 at DDD 75 (p < 0.01).
Results
The study population consisted of older, mostly female, permanently paced patients with sinus node dysfunction and hypertension in sinus rhythm on antihypertensive medication.
22 subjects were included.
Median age was 76 years (IQR 73-78).
16 of the 22 participants were women.
Background
The study addressed a gap in prior pacemaker research, which mostly used acute designs to examine heart rate and central BP, by testing two clinically realistic pacing rates over the long term.
Prior studies examining the heart rate–central BP relationship were predominantly acute, which limits generalisability to long-term settings.
The two strategies compared were a slightly bradycardic rate (55 bpm) and a moderately accelerated physiological rate (75 bpm).
What This Means
This study looked at whether the rate at which a pacemaker sets the heart's pace affects blood pressure measured near the heart (central blood pressure), which is thought to reflect cardiovascular strain better than arm blood pressure. It involved 22 older adults (mostly women, median age 76) with sinus node dysfunction, a condition where the heart's natural pacemaker is unreliable. All had pacemakers and high blood pressure treated with medication. Each person had their pacemaker set to 55 beats per minute for eight weeks and to 75 beats per minute for eight weeks, in random order, with a two-week break between.
Central systolic blood pressure was higher at the slower setting (about 128 mmHg) than at the faster setting (about 121 mmHg). The difference between arm and central pressure, called amplification, was also smaller at the slower rate. This suggests that a somewhat faster paced rate may be linked to a more favourable central blood pressure profile in this group.
The study was small, ran at a single centre, and was exploratory, so the results need confirming in larger trials. It also measured only blood pressure, not clinical outcomes such as heart attacks or strokes. This research suggests that pacing rate may be one factor that influences central blood pressure in older paced patients with hypertension, but it does not show which setting is best for any individual patient.
Joonsalu T, Heinsar S, Serg M, Kals M, Voitk J, Zilmer M, et al.. (2026). Long-Term Effects of Paced Heart Rate on Central Blood Pressure in Patients with Sinus Node Dysfunction and Hypertension: A Randomised Crossover Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62102032