51. ENHANCED EXTERNAL COUNTERPULSATION REDUCES BLOOD PRESSURE IN REFRACTORY ANGINA PECTORIS PATIENTS; A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Refractory angina patients often coexist with hypertension. Uncontrolled hypertension increased the risk of major adverse cardiac event (MACE) and target-organ damage. Enhanced External Counterpulsation (EECP) is a non-invasive treatment that is beneficial in refractory angina pectoris patients. Hemodynamic benefits of EECP to peripheral blood pressure are observed but not yet established. We systematically review the available evidence of the efficacy of EECP in addressing systolic and diastolic blood pressure (SBP and DBP) in refractory angina pectoris patients. We conducted a literature search in MEDLINE and ResearchGate from its inception to January 2021. We included studies that reported SBP and DBP measurement at baseline and after EECP treatment in refractory angina patients. We conducted a meta-analysis of weighted mean differences from baseline to post-intervention for SBP and DBP. We identified 22 studies from 17 articles (n = 1564) consisting of 12 articles EECP only and six articles EECP vs control. Within EECP group, EECP treatment significantly reduce SBP by 6.7 mmHg (MD −6.77, 95%CI −9.09 to −4.45, p = <0.00001, I 2 = 71%) and DBP by 3 mmHg (MD −3.03, 95%CI −4.07 to −2, p = <0.00001, I 2 = 49%). Between-group, EECP treatment compared to control could reduce SBP by 9.1 mmHg (MD −9.15, 95%CI −15.75 to −2.56, p = 0.007, I 2 = 80%) and SBP by 2.6 mmHg (MD −2.68, 95%CI −5.52 to −0.17, p = 0.07, I 2 = 63%). Conclusion: EECP treatment provides additional benefits that reduce SBP and DBP in refractory angina pectoris patients to support controlling hypertension and reduce the risk of MACE and target-organ damage.