Abstract
BACKGROUND: Low diastolic blood pressure (DBP) and high pulse pressure (PP), markers of vascular stiffness, are linked to higher stroke risk and cognitive impairment. Increasing resting heart rate (HR) in pacemaker patients could lower PP and enhance cerebral perfusion. This study examines how raising resting HR affects PP in patients with higher vascular risk. METHODS: A cross-sectional interventional study involved 21 patients (mean age, 77 years; 9 male, 12 female) over age 65 years with dual-chamber permanent pacemakers and normal ventricular function. Hemodynamic parameters were measured at 5-minute intervals at baseline and every 10 beats per minute (bpm) up to 100 bpm using the Finapres NOVA plethysmograph. The effects of higher pacing rates on PP, systolic BP, DBP, and cardiac output were analyzed. RESULTS: Increasing resting HR significantly reduced PP (p < 0.001) from a median of 71 mmHg at 60 bpm to 53 mmHg at 100 bpm. No significant changes were found in systolic blood pressure (P = 0.32), DBP (P = 0.08), or cardiac index (P = 0.25) among different HRs. All patients remained asymptomatic, and no adverse events were observed during the study. The findings indicated variability in response, with most patients showing decreased PP at higher HRs. CONCLUSIONS: An increased HR to 70 bpm reduced PP in most patients with dual-chamber permanent pacemakers and sinus rhythm, suggesting a way to improve hemodynamics in patients with poor vascular compliance. Customized HR settings may optimize PP and reduce the risk of cognitive decline or stroke. Further research is needed to evaluate for risks of pacemaker-induced cardiomyopathy in individuals requiring frequent ventricular pacing.