John Faul1, Danny Schoors2, Sofie Brouwers2, Benjamin Scott3, Andreas Jerrentrup4, Joseph Galvin5, Sandra Luitjens6, Eamon Dolan7. 1. Asthma Research Center, BCF Diagnostics, Connolly Hospital Blanchardstown, Dublin, Ireland. Electronic address: doctorfaul@gmail.com. 2. Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium. 3. Cardiology Department, ZNA Middelheim Hospital, Antwerp, Belgium. 4. Universitätsklinikum Giessen und Marburg, Marburg, Germany. 5. Department of Cardiology, Mater Misericordiae Hospital and the Connolly Hospital Blanchardstown, Dublin, Ireland. 6. Rox Medical, Inc, San Clemente, Calif. 7. Acute Stroke Unit, Department of Medicine for the Elderly, Connolly Hospital Blanchardstown, Dublin, Ireland.
Abstract
OBJECTIVE: Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance. METHODS: Twenty-four patients with COPD and hypertension enrolled in an open label study of arteriovenous shunt creation for COPD. We performed cardiac catheterization at baseline and again 3 to 6 months after the procedure. As a safety measure we also recorded office blood pressure at baseline and again after 3, 6, 9, and 12 months. RESULTS: The procedure increased oxygen delivery (1.1-1.4 L.min(-1)) and cardiac output (6-8.2 L.min(-1)) (P < .001) and lowered both the systemic vascular resistance (P < .001) and the pulmonary vascular resistance (P < .01). After 12 months, however, the average systolic blood pressure was reduced from 145 to 132 mm Hg (P < .0001), and the average diastolic blood pressure was reduced from 86 to 67 mm Hg (P < .0001). CONCLUSIONS: Percutaneous iliac arteriovenous fistula creation for COPD causes a significant and persistent lowering of blood pressure in patients with co-existing hypertension.
OBJECTIVE: Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensivepatients because of a reduction in vascular resistance. METHODS: Twenty-four patients with COPD and hypertension enrolled in an open label study of arteriovenous shunt creation for COPD. We performed cardiac catheterization at baseline and again 3 to 6 months after the procedure. As a safety measure we also recorded office blood pressure at baseline and again after 3, 6, 9, and 12 months. RESULTS: The procedure increased oxygen delivery (1.1-1.4 L.min(-1)) and cardiac output (6-8.2 L.min(-1)) (P < .001) and lowered both the systemic vascular resistance (P < .001) and the pulmonary vascular resistance (P < .01). After 12 months, however, the average systolic blood pressure was reduced from 145 to 132 mm Hg (P < .0001), and the average diastolic blood pressure was reduced from 86 to 67 mm Hg (P < .0001). CONCLUSIONS: Percutaneous iliac arteriovenous fistula creation for COPD causes a significant and persistent lowering of blood pressure in patients with co-existing hypertension.
Authors: John S Clemmer; W Andrew Pruett; Robert L Hester; Thomas E Lohmeier Journal: Am J Physiol Heart Circ Physiol Date: 2019-08-30 Impact factor: 4.733
Authors: Stefan C Bertog; Nathan A Sobotka; Paul A Sobotka; Melvin D Lobo; Kolja Sievert; Laura Vaskelyte; Horst Sievert; Roland E Schmieder Journal: Curr Hypertens Rep Date: 2018-03-19 Impact factor: 5.369