Change in blood pressure following transcatheter aortic valve implantation: predictors and association with prognosis

INTRODUCTION: Aortic stenosis significantly contributes to cardiovascular mortality. While hypertension often coexists with aortic stenosis, 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 1333 patients who underwent TAVI at Sheba Medical Centre between 2008 and 2023. Changes in SBP and 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 men, and 73% had preexisting hypertension. 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). Preexisting hypertension 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.