Background Elevated blood pressure remains the most common modifiable cardiovascular risk factor. Many patients continue to be exposed to this risk due to the failure to attain target blood pressure levels due to pharmacologic resistance. The creation of a 4 mm central iliac arteriovenous anastomosis, a treatment targeting the mechanical properties of the arterial system has recently been shown to reduce average blood pressure in patients resistant to pharmacotherapy.
Objectives We undertook this study to evaluate the impact of central arteriovenous fistula on 24 h peak pressures and blood pressure variability in resistant hypertensive patients.
Methods In this open-label, multicentre, prospective, randomised trial, patients with elevated blood pressure despite therapy were randomised to undergo implantation of an AV coupler device along with previous treatment, or to maintain previous treatment alone. All patients underwent ABPM at baseline and at 6 months.
Results Data is presented on 75 patients who were randomised to arteriovenous coupler therapy (n = 40) or control (n = 35) groups. Peak systolic pressures during the 24 h period were reduced by 17.4 ± 22.1 mmHg, (p < 0.0001) in the AV Coupler group, and by 4.4 ± 23.9 mmHg (p = 0.22) in the control group. Measures of 24 h blood pressure variability such as average real variability (ARV) and time weighted standard deviation (wSD) were both significantly reduced in the treatment group for both systolic and diastolic blood pressure (ARV reduction of 1.4/1.5 mmHg and wSD reduction of 2.6/1.7 mmHg, p < 0.05 for all).
Conclusions In this study we have shown a reduction in blood pressure variability following iliac AV anastomosis creation. The coupling of blood pressure reduction and cushioning of blood pressure peaks and BP variation over the 24-hour period may be of benefit for patients with uncontrolled hypertension.
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