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Heart rate reduction decreases central blood pressure in sick sinus syndrome patients with a permanent cardiac pacemaker

Journal of Human Hypertension volume 32, pages 377–384 (2018)Cite this article

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Abstract

Increased resting heart rate (HR) contributes to higher cardiovascular mortality and morbidity in the healthy as well as in people with cardiovascular diseases, possibly due to elevated blood pressure (BP) among other mechanisms. Data on the relationship between HR and central (aortic) BP remains controversial, however, and concerning β-blockers, it has been proposed that pharmacological HR lowering is associated with augmentation of central BP. We aimed to study the role of pharmacologically unaffected HR on central BP indices in sick sinus syndrome patients with a permanent cardiac pacemaker in the HR range from 40 to 90 bpm. We included 27 subjects (mean age 65.8 ± 9.5 years, 12 men) with a dual-chamber pacemaker implanted due to sick sinus syndrome. We determined central hemodynamic indices noninvasively during an atrial pacing mode at low (40 bpm), middle (60 bpm), and high (90 bpm) HR levels with an oscillometric cuff-based device (Sphygmocor XCEL). There was no difference in central systolic BP at the middle versus the high HR level (mean 121.2 ± 13.0 and 121.2 ± 12.1 mmHg, respectively, P = 0.9), but at the low HR level, it was significantly lower than at the middle HR level (mean 117.2 ± 13.1 and 121.2 ± 13.0 mmHg, P < 0.01). Our acute study provides evidence to suggest that at a HR of <60 bpm, sick sinus syndrome patients may have a lower central BP than at a higher HR, despite the proposed augmenting effects of low HR on central BP.

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Acknowledgements

The present study was supported by Institutional Research Funding No. IUT20-42 from the Estonian Ministry of Education and Science.

Author contributions

TT acquired data, interpreted the results, drafted and revised the manuscript, approved the final version. MS interpreted the results, revised the manuscript, approved the final version. KP interpreted the results, revised the manuscript, approved the final version. JK designed the work, revised the manuscript, approved the final version. MK interpreted the results, revised the manuscript, approved the final version. MZ interpreted the results, revised the manuscript, approved the final version. JE interpreted the results, revised the manuscript, approved the final version. PK designed the work, drafted and revised the manuscript, approved the final version.

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Authors and Affiliations

  1. Department of Cardiology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa Street, Tartu, 51014, Estonia

    Tuuli Teeäär, Martin Serg, Kaido Paapstel, Jaan Eha & Priit Kampus

  2. Centre of Cardiology, North Estonia Medical Centre, 19 Sütiste Street, Tallinn, 13419, Estonia

    Tuuli Teeäär, Martin Serg & Priit Kampus

  3. Heart Clinic, Tartu University Hospital, Tartu, 8 Puusepa Street, Tartu, 51014, Estonia

    Tuuli Teeäär, Martin Serg & Jaan Eha

  4. Department of Biochemistry, Centre of Excellence for Genomics and Translational Medicine, Institute of Biomedicine and Translational Medicine, University of Tartu, 19 Ravila Street, Tartu, 50411, Estonia

    Kaido Paapstel, Jaak Kals & Mihkel Zilmer

  5. Department of Surgery, Institute of Clinical Medicine, Tartu University Hospital, 8 Puusepa Street, Tartu, 51014, Estonia

    Jaak Kals

  6. Estonian Genome Center, University of Tartu, 23b Riia Street, Tartu, 51010, Estonia

    Mart Kals

Authors
  1. Tuuli Teeäär
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  2. Martin Serg
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  8. Priit Kampus
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Correspondence to Tuuli Teeäär.

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The authors declare that they have no conflict of interest.

Additional information

Clinical Trial Registry Number: NCT03245996 (www.clinicaltrials.gov)

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Teeäär, T., Serg, M., Paapstel, K. et al. Heart rate reduction decreases central blood pressure in sick sinus syndrome patients with a permanent cardiac pacemaker. J Hum Hypertens 32, 377–384 (2018). https://doi.org/10.1038/s41371-018-0051-4

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  • DOI: https://doi.org/10.1038/s41371-018-0051-4

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