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Hypertension: an unstudied potential risk factor for adverse outcomes during continuous flow ventricular assist device support

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Abstract

In end-stage heart failure, left ventricular assist devices (LVADs) represent an exciting new frontier in which post-device implantation survival approaches that of heart transplant. However, expansion of this technology is still limited by complications that impact morbidity and mortality. Thus, it is essential to identify and optimize modifiable predictors of poor outcomes. One such predictor may be hypertension (HTN). Not only may chronic HTN as a traditional cardiovascular risk factor be present during long-term LVAD support, but HTN may also contribute to device malfunction or device-associated complications. Although current guidelines identify blood pressure (BP) control as important to outpatient continuous flow (CF) LVAD management, there is no evidence base to support these guidelines. Indeed, our comprehensive literature search did not identify any studies that evaluated post-device implantation HTN as a potential predictor of adverse CF-LVAD outcomes. HTN among CF-LVAD patients is likely a relatively unstudied factor because of difficulties using standard noninvasive techniques to measure BP in the setting of reduced pulsatile flow. Fortunately, recent research has elucidated the meaning of Doppler BP measurements and validated a slow-cuff deflation system for BP measurements in the setting of CF-LVAD support. Therefore, CF-LVAD researchers and clinicians may (1) consider potential mechanisms relating HTN to poor outcomes, (2) realize that HTN management is a stated goal despite scarce evidence, and (3) utilize the new reliable and valid methods for outpatient BP measurement that make research and management possible. It is critical and now feasible that research on HTN in the CF-LVAD patient population move forward.

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Abbreviations

AI:

Aortic insufficiency

BP:

Blood pressure

CF:

Continuous flow

DBP:

Diastolic blood pressure

HTN:

Hypertension

INTERMACS:

Interagency Registry for Mechanically Assisted Circulatory Support

LVAD:

Left ventricular assist device

MAP:

Mean arterial pressure

PP:

Pulse pressure

SBP:

Systolic blood pressure

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Acknowledgments

Dr. Wasson would like to acknowledge the NIH T32 Training Grant HL007343. Dr. Paolo Colombo would like to acknowledge the A. L. Mailman Family Foundation White Plains for its research support. Dr. Ulrich Jorde would like to acknowledge the Schwartz Scholarship.

Conflict of interest

Dr. Ulrich Jorde has received consulting fees of less than $5000 annually each from Thoratec, HeartWare, and Jarvik. Dr. Yoshifumi Naka has received consulting fees of less than $5000 from Thoratec. Dr. Nir Uriel has received consulting fees of less than $5000 from HeartWare.

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Authors and Affiliations

  1. NewYork-Presbyterian, Columbia University Medical Center, 622 West 168th Street, PH12-134, New York, NY, 10032-3720, USA

    Lauren T. Wasson, Melana Yuzefpolskaya, Michiyori Wakabayashi, Hiroo Takayama, Yoshifumi Naka, Nir Uriel, Ulrich P. Jorde & Paolo C. Colombo

  2. New York Institute of Technology, New York, NY, USA

    Michiyori Wakabayashi

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Ryan T. Demmer

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  1. Lauren T. Wasson
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  2. Melana Yuzefpolskaya
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Correspondence to Paolo C. Colombo.

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Ryan T. Demmer and Paolo C. Colombo have contributed equally to this manuscript.

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Wasson, L.T., Yuzefpolskaya, M., Wakabayashi, M. et al. Hypertension: an unstudied potential risk factor for adverse outcomes during continuous flow ventricular assist device support. Heart Fail Rev 20, 317–322 (2015). https://doi.org/10.1007/s10741-014-9458-3

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