Abstract
Background: Hypertension is a modifiable risk factor for ASCVD. Enhanced External Counterpulsation (EECP ® ) is an FDA-approved, non-invasive treatment modality for patients with angina and symptoms of ischemic heart failure. Various studies have demonstrated hemodynamic changes with EECP ® therapy, but the true magnitude of benefit remains unknown. We conducted a meta-analysis to assess the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) post- EECP ® therapy. Methods: A literature search across multiple databases was conducted from its inception to March 2020. Studies evaluating the impact of EECP ® in chronic stable angina patients that reported systolic and diastolic blood pressures were extracted. Human studies published in English, where patients completed 35 hours of EECP ® (administered as 1-hour sessions) were included for analysis. Studies that reported data in multiple arms were treated as individual studies. The weighted mean difference from baseline for SBP and DBP was calculated using the DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed by the I 2 statistic with publication bias evaluated using the Egger bias statistic. Subgroup analyses were performed to assess for clinical heterogeneity. Results: We identified 272 articles, of which 15 unique studies (n=659) reporting data on systolic and diastolic blood pressure were included. Post- EECP ® treatment, SBP decreased by 8.9 mmHg (95% CI 4.0 to 13.7 mmHg, I 2 =87.3%) and DBP reduced by 3.6 mmHg (95% CI 2.1 to 5.0 mmHg, I 2 =38.9%). Patients with a baseline SBP 130 mmHg appear to derive greater benefit (SBP reduced by 13.0 mmHg, 95% CI 8.3 to 17.6, I 2 =70.4%) compared to patients with a baseline SBP<130 (SBP reduced by 3.2 mmHg, 95% CI 0.4 to 6.0, I 2 =25.2). The Egger bias statistic showed no publication bias for the primary endpoints (both p-values>0.33). Conclusion: EECP ® treatment reduced SBP and DBP by over 8 and 3 mmHg respectively. The pleiotropic benefits from EECP ® provide additional hypertension control in patients with chronic stable angina.
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