Systolic Blood Pressure and Risk for Ventricular Arrhythmia in Patients With an Implantable Cardioverter Defibrillator
Section snippets
Methods
MADIT-RIT was a multicenter, randomized, prospective, controlled clinical trial evaluating patients with approved indications for primary prevention ICD or CRT therapy. The trial design and results have been published elsewhere.6 Briefly, patients were randomized to standard ICD programming (arm A), a high-rate therapy cutoff (≥200 beats/min) programming strategy (arm B), or a prolonged detection duration (60-second delay for ventricular tachycardia [VT] zone 170–199 beats/min, 12-second delay
Results
The distribution of SBP in study patients is presented in Figure 1, showing a normal distribution with a mean SBP of 123 ± 19 mm Hg and a median of 121 mm Hg (IQ range 96 to 146). Among 1481 study patients, 727 (49%) patients had lower SBP and 754 (51%) had higher SBP. Relevant baseline clinical characteristics of patients with SBP≤120 mm Hg and SBP >120 mm Hg are shown in Table 1. Patients with SBP≤120 mm Hg were younger, were less likely to have diabetes mellitus and had a lower LVEF. They
Discussion
The main finding of this study is that patients with indication for ICD or CRT-D implantation and with lower SBP at baseline (≤120 mm Hg) are at greater risk for ventricular tachyarrhythmia compared with those with higher baseline SBP.
Elevated SBP has been described a surrogate marker for VTA events in large population studies1,3,9 and in patients with HF, albeit with preserved ejection fraction (EF).10 There are many mechanistic explanations for these finding. A possible common pathway in
Credit Author Statement
Eyal Nof, Roy Beinart, Ilan Goldenberg:Conceptualization, Methodology, Writing- Original draft preparation; Arwa Younis, David Huang, Mehmet K. Aktas , Rosero Spencer and Valentina Kutyifa: Methodology , Visualization, Investigation. Scott McNitt: Statistical Ananlysis
Disclosures
The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.
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Cited by (0)
Dr. Valentina Kutyifa has received Research grants were came from Boston Scientific HQ 300 Boston Scientific Way Marlborough, MA 01752-1234. Zoll HQ: 269 Mill Road Chelmsford, MA 01824-4105 U.S.A. Medtronic: 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA. Mirowski Foundation: Chestnut Hill Massachusetts, USA.