Change in blood pressure following transcatheter aortic valve implantation: predictors and association with prognosis
A L O N Kaplan, V C Copeland, E R Regev, P F Fefer, D R Rott, A S Segev, E M Maor, E G GrossmanAbstract
Introduction
Aortic stenosis (AS) significantly contributes to cardiovascular mortality. While hypertension (HTN) often coexists with AS, the long-term effects of transcatheter aortic valve implantation (TAVI) on blood pressure (BP), the predictors of BP changes, and their prognostic significance remain incompletely understood.
Methods
We conducted a retrospective cohort study of 1,333 patients who underwent TAVI in our Medical Centre between 2008 and 2023. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were divided into quintiles (lowest, intermediate, and highest) and assessed for associations with all-cause mortality using Kaplan-Meier survival curves and Cox proportional hazards models, adjusted for clinical and echocardiographic variables. Multinomial logistic regression identified predictors of BP changes.
Results
The mean age was 81 years; 50% were male, and 73% had pre-existing HTN. Mean baseline SBP and DBP were 135 and 69 mmHg, respectively. Post-TAVI, SBP increased in 53% of patients, and DBP in 47%. Over a median follow-up of 4.6 years, higher post-TAVI SBP and DBP were independently associated with improved survival, after adjustment for clinical and echocardiographic confounders. Lower baseline left ventricular ejection fraction (LVEF) predicted increased SBP (p<0.001), and female sex predicted increased DBP (p<0.001). Pre-existing HTN did not predict BP changes.
Conclusion
Post-TAVI BP elevation is linked to better long-term survival, especially among patients with reduced baseline LVEF, and may reflect a beneficial hemodynamic response rather than comorbidity. Lower baseline LVEF and female sex are independent predictors of this response. These findings support permissive management of BP changes post-TAVI to improve patient outcomes.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.