A PACEMAKER TO LOWER HIGH BLOOD PRESSURE??
I didn’t know this but every year, “more than one million patients are implanted with pacemakers.” Of those millions, over 70% also have hypertension (high blood pressure). Long-standing high blood pressure leads to enlargement of the heart, thickening of the heart muscle, and weakening (dysfunction) of the left ventricle. It just doesn’t pump as effectively because it is pumping against a higher resistance. Hypertension, then, increases the work load of the heart, and it eventually tires and cause the heart to fail.
Hundreds of drugs are available for lowering BP, but they don’t always work, even when taken in combination with one another. When that happens, patients are put at risk of having those heart problems mentioned previously or a stroke. An alternate treatment is then sought to lower systolic BP and prevent heart failure.
That alternate treatment is called atrioventricular interval modulation, or AVIM for short, and employs a “pacing algorithm which has been incorporated into a dual-chamber pacemaker.” So if you have uncontrolled high BP plus the need for a dual-chamber pacemaker, AVIM is the treatment for you. As far as I understand it, the regular pacemaker is altered in a way that results in a 11-12 mmHg lowering of the systolic BP. “Clinical studies have demonstrated that AVIM therapy immediately, substantially, and persistently reduces blood pressure in patients who were candidates for a dual-chamber pacemaker…AVIM reduces ventricular filling (preload) and total peripheral resistance (afterload).” That translates into less blood being allowed into the heart and less resistance the heart has to pump against. That effectively lowers the blood pressure and reduces the heart’s workload.
Whether AVIM becomes the standard of care is still way in the future. It does work, however! It’s just not known if the invasive nature of AVIM will have a detrimental effect on patient acceptance. The technology of AVIM is difficult to understand, but if it works and is safe, that’s a moot point.
References: Glauber W. Patients with High Blood Pressure Could One Day be prescribed a Pacemaker. Medscape 2025 July 14.
Chovanec M, et al. Pressure-Volume Analysis Demonstrates Short-and Long-Term Hemodynamic Effects of AtrioventricularInterval Modulation Therapy in hypertension. JACC Clin Electrophysiol 2025 July 22:S2405.
Fudim M, et al. Effects of Atrioventricular Interval Modulation Therapy in Subjects with Hypertension and Diastolic Dysfunction JACC Advances 2025 July:4(7):1-3.
