BP elevation after TAVI predicts longer survival

Blood pressure (BP) elevation following transcatheter aortic valve implantation (TAVI) appears predictive of better long-term survival, particularly among patients with reduced baseline left ventricular ejection fraction (LVEF), suggests a study.

Moreover, post-TAVI BP elevation “may reflect a beneficial haemodynamic response rather than comorbidity,” according to the investigators. “Lower baseline LVEF and female sex are independent predictors of this response.”

A total of 1,333 patients (mean age 81 years, 50 percent men, 73 percent had pre-existing hypertension) who underwent TAVI between 2008 and 2023 were included in this retrospective cohort study.

The investigators divided changes in systolic (SBP) and diastolic blood pressure (DBP) into quintiles (lowest, intermediate, and highest) and assessed for associations with all-cause mortality using Kaplan‒Meier survival curves and Cox proportional hazards models, adjusting for clinical and echocardiographic variables. They also identified predictors of BP changes using multinomial logistic regression.

The mean SBP and DBP at baseline were 135 and 69 mm Hg, respectively. SBP and DBP increased in 53 percent and 47 percent of patients, respectively, after undergoing TAVI.

After adjusting for confounders, higher SBP and DBP post-TAVI independently correlated with prolonged survival over a median follow-up of 4.6 years. Lower baseline LVEF predicted a higher SBP (p<0.001), while female sex predicted an elevated DBP (p<0.001). On the other hand, pre-existing hypertension was not predictive of BP changes.

“These findings support permissive management of BP changes post-TAVI to improve patient outcomes,” the investigators said.